Dismantling Obamacare is expected to be among the first tasks Congress takes up this month as Republicans take control of the White House, Senate and House of Representatives.
Republican leaders, including President-elect Donald Trump, have vowed to replace President Barack Obama’s health law, officially dubbed the Patient Protection and Affordable Care Act.
Since rolling out in 2013, the law has provided health insurance to more than 25 million previously uninsured Americans through expanded Medicaid benefits and online exchanges where consumers can shop for insurance and receive cost-cutting tax credits.
But critics say the law isn’t working. Big insurers, including UnitedHealth Group and Aetna, won’t sell plans on the exchange next year – citing losses due higher than expected patient costs. On average, plans sold on the exchange are expected to climb by 25 percent next year.
“It’s sort of collapsing from its own weight,” U.S. Sen. Rob Portman, (R-Ohio) told WCPO. “We do need to repeal it, but more importantly we need to replace it and put in place something that will actually give people who are currently getting coverage, either under the exchanges or on Medicaid, a sense of security so they know the rug is not going to be pulled out from under them.”
But so far, Republicans have offered no such plan.
As lawmakers, consumers and insurers consider the road ahead, here are nine things to know about what’s at stake.
How might Congress repeal the law?
Republicans in Congress are considering turning to a special process known as budget reconciliation – which allows existing laws to be changed in order to bring federal spending in line with a budget resolution.
Such a move would allow Congress to essentially conduct a partial repeal of the law – since changes through this process can only deal with items tied to the federal budget. Republicans tried this in January 2016, writing into that effort a two-year delay for most items they wanted to repeal. But Obama vetoed the bill.
What would change under a partial repeal?
Key pieces of the law could be eliminated, including Medicaid expansion, federal tax credits for exchange plans and the individual and employer mandates.
Items that couldn’t be reworked through this process are many of the insurance market reforms, including prohibiting insurers from denying insurance based on pre-existing conditions and coverage of essential benefits such as physicals, prescription drugs and addiction treatment services.
What would be the impact?
Of the 29.8 million newly uninsured under the ACA, it’s estimated that 22.5 million people would then become uninsured by 2019 if the premium tax credits, Medicaid expansion and the individual mandate were eliminated, according to a report by the Urban Institute, a D.C.-based nonprofit.
More than four out of five of those losing insurance would be working families, according to the report.
What’s the local impact?
In Ohio and Kentucky the number of uninsured is expected to nearly double, with a projected 964,000 uninsured in Ohio and 486,000 In Kentucky.
Will this impact people who get health insurance through their employer?
Not likely. Largely, these changes would impact people who buy their health insurance through the marketplace or have become newly eligible for health insurance.
If Congress lifts the mandate that employers with more than 50 full-time employees must provide health insurance, some employers may choose to drop coverage. But this impact is expected to be limited because more than 95 percent of U.S. employers have fewer than 50 full-time employees.
If I buy a marketplace plan, can I keep it in 2017?
Yes. It’s expected that any measure passed by Congress would include at least a two- to three-year delay before going into place.
Can I still buy a plan through the marketplace?
Yes. Open enrollment for insurance sold through marketplace at Healthcare.gov runs through Jan. 31. Already, more than 1 million Americans have signed on.
How quickly could all of this happen?
Even if Congress passes a measure that includes a multi-year delay, experts warn that the biggest impacts could likely to be felt as early as 2018 as insurers pull out of the marketplace in anticipation of its collapse, said Linda Blumberg, a health policy analyst and author of the Urban Institute report.
“Even if you delay certain repeals, you can cause a lot of disruption and financial difficulty for insurers and consumers right away,” she said.
Is there an agreed-to plan to replace Obamacare?
No. Republican leaders have said they want to craft a plan that gives states – instead of the federal government – more control, but details have yet to be shared.
“You don’t solve all the problems, just by undoing what we have,” Blumberg said. “You’re going face a lot of issues with whatever gets put in place.”