Is Obamacare over? On his first day in office, President-elect Donald Trump has repeatedly vowed, he will abolish the Affordable Care Act, the contentious health care law that has been both applauded and hated across the country.
But whether that will happen – or what it will mean for consumers – is one of the big question marks in the aftermath of Tuesday’s election.
“(Trump) may not be able to repeal the law on the first day completely, but there’s enough that can be done with the support of Congress to begin to dismantle the program. All Californians should take that seriously,” said Gerald Kominski, director of the UCLA Center for Health Policy Research in Los Angeles. “The potential damage of dismantling the (Affordable Care Act) could put upwards of 20 million people back on the rolls of the uninsured.”
But some of those insured say they’re ready to be dumped from the federal health insurance program.
Sacramentan Jim Glen is a self-described liberal who voted for Hillary Clinton. But he’s been outraged by the “ludicrous” cost of his Covered California health insurance premiums, which he said have doubled over the last three years.
“I think this election was lost because of this issue,” said Glen, 58. “Those premium letters just went out and people were seeing their increases. It had to be in the forefront of people’s minds.”
The former billiards room owner and his wife, a hairdresser, are self-employed but not eligible for federal subsidies. Next year, their premiums are bumping up another 20 percent, from $937 a month to about $1,125, for the cheapest type of Covered California plan. “If you get a subsidy, that’s great for you. But the people really getting hit on this are people like my wife and myself.”
Since 2011, when the Affordable Care Act was launched, more than 20 million Americans have signed up for health insurance coverage, many for the first time. But it’s remained hugely unpopular in some areas because of its mandates, tax subsidies and, more recently, complaints about soaring premiums and increases in copays, prescription drugs and other costs. This year, average Obamacare premiums jumped about 24 percent nationwide for 2017. Covered California, one of 15 states that operates its own independent exchange, held its average increases to 14.3 percent.
The federal health law, known as Obamacare, would be eliminated and individuals would be free to buy insurance on their own, if they choose, under proposals outlined on Trump’s presidential website and by House Speaker Paul Ryan, a Wisconsin Republican. Trump and Ryan have suggested a number of reforms to create a more price-competitive market: allow insurers to sell across state lines; require price transparency by doctors and hospitals; let individuals open tax-free Health Savings Accounts; allow access to overseas pharmacy drugs; and give states Medicaid funds in block grants to use as they see fit.
If Obamacare is repealed, it would lead to 53.5 million Americans – roughly 19.4 percent of the population – being uninsured by 2021, according to a recent study by the Urban Institute and the Robert Wood Johnson Foundation. An estimated 1 million of those would be young adults, who are currently allowed to stay on their parents’ insurance plans up to age 26.
In California, the study estimates that 7.5 million would be uninsured by 2021; in 2014, the number of uninsured was about 3.8 million.
Today, millions of Americans are in the midst of the health program’s annual sign-up season for 2017 coverage, which runs through Jan. 31. For many, the election raises new questions: What happens if the program is repealed? Should I enroll this year? Will my premiums go down?
Calling the situation “a huge political minefield,” state Sen. Ed Hernandez, D-West Covina, chair of the state Senate’s Health Committee, said the new Trump administration faces the unpleasant prospect of letting millions of current Obamacare insurance enrollees lose their current coverage.
While it would be relatively easy for California to set up its own state-sponsored version of the federal program, the problem would be paying for subsidies to help offset monthly premium costs for low-income consumers, he said. “If the federal subsidies are pulled away from state governments, the question is where would those (replacements) come from? Is the Legislature willing to take it from the general fund? Are voters willing to tax themselves? ... There are a lot of unknowns.”
In the meantime, Covered California officials and others are urging consumers to continue with their coverage.
“Covered California remains focused on open enrollment,” said executive director Peter Lee, in a statement. “We want to make sure consumers know their options. ... In the weeks and months ahead, Covered California looks forward to sharing our lessons to inform policy changes nationally.”
UCLA’s Kominski urged those who are considering buying or renewing a Covered California policy to sign up. A current version of the Ryan proposal, he said, includes a provision that would protect people with pre-existing conditions, allowing them to continue their insurance if they have maintained coverage.
“That’s really important for anyone considering buying or renewing a policy in the exchange,” Kominski said. “If this replacement plan goes into effect, you’re going to need to demonstrate that you were continuously enrolled. Otherwise, you could be out in the cold again and denied coverage.”
The prospect of Obamacare being abolished is dispiriting to those who see it as a boon to California consumers. “It is so unthinkable given the progress we’ve made in California,” said Anthony Wright, executive director of Health Access California, a consumer group. “Not that we didn’t have problems, but there was clear, consistent progress and now it’s all at risk.”