WASHINGTON, December 20, 2016 — When Donald trump won the election last month, one big question was what would happen to the Affordable Care Act, or “Obamacare.” Repealing Obamacare was one of Trump’s major campaign promises, but even if he does manage to get rid of it, health care industry professionals and experts say they aren’t too concerned.
A few days after the election, Trump seemed to soften his anti-Obamacare stance. Following a meeting with President Obama, Trump said he wanted to keep two major elements of the legislation: forbidding insurance companies from denying coverage to people with pre-existing conditions, and allowing people to stay on their parents’ insurance plan until age 26.
Weeks later, Trump announced Representative Tom Price as his pick for secretary of the Department of Health and Human Services. Price, a former orthopedic surgeon, has been a harsh critic of Obamacare. His proposal for replacing it is to introduce tax credits in lieu of the individual mandate and other provisions of the act.
Even as HHS secretary, Price cannot eliminate Obamacare. That job will fall to the GOP-controlled Congress, where Republicans have been adamant about their plans to repeal it.
Democrats and some healthcare industry experts have expressed concerns about the consequences of eliminating Obamacare without an actual replacement plan. This might hurt markets due to the destabilization of insurance markets and the loss by millions of people of the health insurance they obtained through Obamacare.
While healthcare industry professionals and experts agree that Obamacare is headed for an exit, they don’t think the change will be as abrupt or calamitous as some fear it will be.
When Trump takes office in January, legislation to repeal Obamacare will almost certainly make its way through Congress to the Oval Office, where President Trump will sign it. However, it won’t be like flipping a switch, with Obamacare and its vast regulatory underpinnings going “poof.”
The end of Obamacare will be much more like Britain’s departure from he European Union, or like stopping a supertanker traveling at full speed. House Majority Leader Kevin McCarthy has said there would be a transition period to bring in changes gradually.
Senate Finance Committee Chairman Orrin Hatch says the transition period could take as long as three years. Further complicating things is the possibility of Democrats regaining control of the House and Senate in the 2018 midterm elections. Should that occur, efforts to replace Obamacare with a Republican-approved alternative will be difficult.
Kathleen Harrington, chair of Policy and Government Relations for the Mayo Clinic in Rochester, Minn., spoke positively of Trump’s tentative plans for Obamacare. “We are very encouraged with the approach we’re hearing so far from President-elect Trump in terms of having a focused review and removing certain parts of it,” she said.
Vice President-elect Mike Pence could influence the Trump Administration’s plans for Obamacare. Consultant Seema Verma created a Medicare expansion plan while Pence was governor of Indiana. She is Trump’s pick for leader of the Centers for Medicare and Medicaid Services.
American Enterprise Institute Joseph Antos believes Medicaid expansion could become a reality with Verma appointed.
“It’s pretty clear that she is on the side of expanding Medicaid, but putting some conditions on it,” Antos said.
Republicans in Congress want to place the burden of Medicare programs and the healthcare for individuals on the states rather than on the federal government. Insurance companies say this will be a benefit, as it will allow for more flexible healthcare plans to be instated.
It might seem like the situation is simple: Obamacare stays or it goes. In reality, Obamacare might stick around for years, at least in spirit, even if it is repealed. How it goes will be at least as important as the fact of its departure.