With Republicans poised to take charge of both Congress and the White House, they may finally be in position to make good on their oft-stated intention to “repeal and replace” the Affordable Care Act, better known as Obamacare.
But local experts say they are unlikely to scrap the ACA entirely.
As Business Report details in a new feature from the current issue, lawmakers are under political pressure to keep the most popular elements of the act, while dumping the mandates and fees that arguably make everything else possible.
Shortly after being elected president, Donald Trump suggested he was open to amending rather than repealing the ACA, but he has since tapped Georgia Rep. Tom Price, a staunch repeal proponent, as secretary of Health and Human Services.
Dr. I. Steven Udvarhelyi, president and CEO of Blue Cross and Blue Shield of Louisiana, hopes politicians keep in mind how all the parts of the ACA fit together.
“There needs to be an orderly transition,” he says. “There were a number of interrelated pieces to the Affordable Care Act. So when you decide you want to change one piece and not the interrelated pieces, it creates unintended consequences.”
At its core, the ACA was a grand bargain. Put simply, almost everyone in America was required to buy health insurance. In return, the insurance industry was not allowed to deny coverage to those who needed it most. The second part of that deal is wildly popular; the first, not so much.
So what happens if the guaranteed-issue provision is maintained while the mandate to buy insurance is not? Udvarhelyi suggests the recent price increases for many policies may be a preview.
He suggests the mandate could be replaced with different incentives. America’s Health Insurance Plans, the industry’s main lobby, suggests a new approach could include late enrollment penalties and waiting periods, along with a greater role for health savings accounts and high-risk pools to cover sick people.
Most of the people buying policies on the federal exchange get subsidies. Congressional Republicans say they want to eliminate those subsidies while also rolling back the Medicaid expansion, which worries a former doctor like Udvarhelyi.
“We’ll lose some of the access gains we’ve had, which I think is a step backward,” he says.