Update for ObamaCare Coverage and ObamaCare Repeal in 2017
Below is an updated overview of where ObamaCare and its replacement plan stands now that Trump has been elected and repeal efforts have begun.
This page will be updated as we learn more, keep checking back for updates on the Republican (GOP) “defund, repeal, delay, replace plan.” Skip around the page to make sure you catch all the main points. There is no single thing to know, there are many.
UPDATE 2019: This plan never passed, and thus the specifics here are of historical interest only.
UPDATE: House republicans unveiled “the American Health Care Act” “AHCA” (The New ObamaCare Replacement Plan AKA TrumpCare 1.0) shortly after Trump’s inauguration. So much up to that point had been a guessing game, but today that is less true. The AHCA legislation by Republicans, an attempt at an amendment to the AHCA, and the new sets of regulations from the Trump administration clearly illustrates that Republicans are moving forward with a version of Paul Ryan’s “Better Way” plan. This plan didn’t pass the House, but that doesn’t mean we have seen the last of it. In fact, the bill will almost certainly be coming back to the table in different forms. That means, in words, there is A LOT going on. All of that said, understanding the AHCA is a good way to understand what could be in store for healthcare, and on that note the plan has its pros and cons (just like ObamaCare has its pros and cons). Still, we can sum up all those pros and cons quickly by saying quoting the CBO’s cost projections for the AHCA: An estimated 52 million people would be uninsured under the Republican health care plan by 2026, compared with 28 million who would lack insurance that year under ObamaCare. In other words, the GOP plans to try to save money and reduce costs via deregulation, which will result in tens of millions loosing coverage. That obviously helps large employers and industry and the wealthy, is OK for some middle class, and hurts the sick, poor, and seniors (very generally speaking). Learn more about TumpCare 1.0 vs. ObamaCare.
IMPORTANT: From this point in the page forward you’ll find a number of past updates. So much has happened in such a quick amount of time it is hard to weave into a readable story. The above is really all you need to know (that is very little has changed despite a number of attempts and the ACA is still the law of the land), the rest of the page will offer insight into past updates.
PAST UPDATE: Although its far too early for ObamaCare supporters to celebrate, recent language used by the GOP hints that the plan will “repair ObamaCare” rather than “repeal, delay, replace”. This hints that Trump and the Republicans will opt to take a more methodical approach to improving the Affordable Care Act, one that won’t send insurers who price months in advance into a tailspin (just the sort of thing that was actually being called for by supporters of the law in the Obama era; AKA GOP supported reform). We will keep you updated on the details as the year rolls along, for now, the rest of the information below will give you an idea of what “the plans” have looked like so far.
PAST UPDATE: Repeal of some key provisions is near certain, and Republicans have already begun the process via what is known as “budget reconciliation.“ Despite this, ObamaCare is on until further notice. If you haven’t gotten covered yet, you should before the changes begin Different replacement plans are in the works (and although there is no official replacement, I’ve read the past GOP bills and can essentially tell you what is in there… it is what is in HIP 2.0, the House “Better Way”, the Price plan, and of course Trump’s plan). That means there will likely be replacements that look like they are keeping protections like the preexisting ban, but aren’t. Keep checking back for updates.
PAST UPDATE: Trump has promised a “simultaneous repeal and replace” plan (or “near simultaneous” plan), he has also promised it would be “better than ObamaCare”. In fact, Trump has gone as far as to promise “insurance for everybody”. Still, for now, 20 million lives are on the line, and for their sake and ours, we need to hold the GOP accountable and the President-elect to his words. Listen to his exact words in the video below and make a bookmark. See also: TrumpCare (which annoying will no longer include “debating drug prices”), Trump’s order, updates on Price and Paul plans, and past Republican health plans. Newly unveiled plans include the Cassidy-Collins plan, the Ron Paul ObamaCare Replacement Act (S.222), The Lower Drug Costs Through Competition Act (not a full replacement plan, but a notable reform plan), and of course… our plan in which we try to achieve universal coverage while retaining provisions suggested by the GOP plans. There have been many ideas floating around, but generally all of them look like the House “Better Way” and Price plan (so that is worth keeping in mind). That means we are almost 100% going to get business as usual GOP healthcare with the preexisting conditions exclusion… that is unless America makes enough noise if and when a replacement plan is brought to the table for public feedback. There is room for compromise and reform, but so far it has just been the GOP reframing their “better way” plan.
THE EFFECTS OF REPEAL: Some past Republican repeal and replace plans have had drastic effects on the budget, costs, and coverage. See what the CBO projects would happen if ObamaCare was replaced with the past Republican plan H.R. 3762 (hint: premiums are projected to double and 32 million are projected to be uninsured). This doesn’t mean a final “TrumpCare” plan will do this, it means that it could if it looks like the stock Republican plan.
On this page we answer questions like: What will happen to ObamaCare in 2017? Will it be repealed? Will there be a simultaneous repeal and replace like Trump promised? What do the Republicans get right in past replacement plans? Will the GOP implement their repeal and delay plan, or will they replace quickly as promised? What provisions are on the chopping block? Will the GOP’s “Continuous Coverage Exclusion” For Pre-Existing Conditions replace the mandate? Should we embrace Pence’s Medicaid solutions and Price’s HSAs despite other gripes? Do Price and Pence even plan to ask our opinion, or is this just going to be a rhetoric fest of “death spirals” and “the GOP don’t have a plan”?
Updates and Facts on ObamaCare Repeal and Replace
Obamacare is being repealed in a complex way that involves both budget measures and a repeal bill, but that doesn’t mean key provisions (like cost assistance, Medicaid expansion, or preexisting conditions protections) will be repealed right away. Instead, in simple terms, the implementation of the repeal of key provisions will likely be “delayed” (why we call it “defund, repeal, delay, and replace”, the plan includes all these things).
In the meantime, open enrollment 2017 is still on and none of the ACA provisions have been repealed yet!
That means open Enrollment 2017 is on, cost assistance is available to many families making between 100% – 400% of the federal poverty level via the marketplace, Medicaid is still expanded to those making less than 138% of the poverty level in states that expanded, insurers can’t deny you, drop you, or charge you more for having a preexisting condition, and the mandates are still in effect (so employers must still offer coverage to full-time employees and there is still a fee for not having coverage).
It is unlikely, but not impossible, that these provisions will be repealed until at least 2018 due to logistics (although some may, especially if they are replaced). Keep checking back for updates, or see ObamaCare 2017 Repeal and Replace Updates for more details.
Speaking loosely, many [but certainly not all] politicians are not being fully honest about all the implications of the GOP plan. The GOP tells their base they are going to “repeal Obama’s legacy”, but they say publicly they will “simultaneously repeal and replace”. Democrats say the GOP will repeal everything, but past GOP plans (of which we can indeed look at legislation, like Price’s plan) show a willingness to build on ObamaCare via their “replacement” plans. Generally, all politicians know, a full repeal isn’t going to happen, and what we are really fighting over is how and if to repeal and replace key provisions.
The confusion stems mainly from the fact that Republicans haven’t been as forthcoming about a plan as they have about “full repeal”. Pair this with the fact that the ACA is already confusing, and we get a very complex situation.
Complexities aside, there is real cause for concern. 20 million newly covered, plus everyone who has been sick in the past, or relies on subsidies, or on Medicaid, or on Medicare, or on Social Security, or is employed through work, etc is in information limbo and really could lose their assistance.
Despite what anyone says, Republicans and Democrats have good ideas for healthcare. We can confirm this by reading past GOP plans, Bernie’s plan, and the ACA itself. However, I only know this from reading all the plans and synthesizing the data. This is not really public knowledge, and has required lots of detective work on our part. It is unreasonable to expect us to play detective on “what maybe is in the plan” while Republicans focus on repeal. We need to get politicians on both sides of the isle working together instead of beating each other over the head with our healthcare.
What Does a Replacement Plan Look Like?
Despite popular opinion, a healthcare wonk will notice that many provisions in past GOP healthcare plans are “pretty darn workable” and only a few key provisions are in true jeopardy to start (the ones that can be repealed by defunding: Medicaid, Tax Credits, Out of Pocket Assistance, and the mandates).
In general, although we don’t know exactly what they will do, we can assume that the GOP really only wants to replace a few key ObamaCare coverage provisions and protections and add a few things in a few more like “sell insurance across state lines” (the idea that they want to repeal the whole thing is often part spin).
What is wrong with their plans is far more nuanced and complex than is often eluded (because it is complex and they have been unclear about their plan, it opens the door for rhetoric and worry).
For example, their fix for preexistings has too long a period in which people need to buy back into a plan. I have a number of fixes for this (some of which are here), but we need a plan on the table so we can put a fix forward.
We can fix Better Way all day, but if the GOP doesn’t try to pass Better Way, or they don’t tell anyone you are going to implement Better Way, then why are we coming up with fixes for it?
Likewise, HIP 2.0 (Pence’s respectable Medicaid solution) has some really great qualities and could easily form the basis of a public option (with a HSA eligible buy-in for higher income Americans), but we don’t know if it is on the table.
Obama has said he will support a plan that covers the 20 million and works, if he supports it, then i’m sure other Democrats will, thus we should be seeking to turn the GOP’s plan into a plan that meets those standards (or risk at least another 4 years of turmoil). To do this, we need the GOP to “show us the plan”.
NOTE: Some replacement provisions in past Republican plans have been lackluster. For example, to point to this major sticking point again, the GOP’s “Continuous Coverage Exclusion” For Pre-Existing Conditions replaces ObamaCare’s ban on preexisting conditions with a requirement that anyone with more than a 60 day gap in coverage to face exclusions for preexisting conditions for 18 months while they buy back into a plan. Likewise, Republicans plans often offer tax credits based on age rather than income. Both these provisions stands to hurt lower income Americans, and the working class when they get sick and need the safety net! These provisions weren’t in Trump’s “TrumpCare plan” specifically, but they are in most other GOP plans (including Tom Price’s plan). Watch out for replacements that sound “the same” but aren’t. ObamaCare isn’t “in a death spiral” today, just like it didn’t “kill our grandmothers” back in 2009. The rush to repeal is political, not for the people. If there is a great replacement plan, “show us“.
How to Understand the Conflicting Repeal Plans
It is still uncertain as to what will happen to ObamaCare under Trump. We know Trump and Republicans plan to act quickly, but details have been sparse. Here is what we know:
Trump has promised a “simultaneous repeal and replace” plan, Congressional Republicans have begun implementing a “repeal and delay” plan (by voting to defund key provisions of the Patient Protection and Affordable Care Act via “budget reconciliation“) which could delay a replacement for years (potentially forever), President Obama has said he will support a better plan that offers affordable coverage to at least the 20 million ObamaCare (the Affordable Care Act, ACA) does, and Democrats will likely follow Obama’s lead.
If Obama, Democrats, and Trump get their way, then we can expect a workable replacement plan. If Congressional Republicans get there way, we may face a delay (that means some defund and repeal measures are passed now, but they set to be implemented later while a replacement plan is worked out).
With that said, it doesn’t seem likely that a workable plan that is agreed on by Democrats and Republicans can be whipped up in a few weeks.
The parties have had decades to hash out their healthcare differences, and the GOP has had 8 years to suggest a replacement, so it is a little hopeful on Trump’s part to think he can rally Congress to action (after-all, Congress makes the laws, not the President, and Republicans control the House and Senate). Still, nothing is impossible.
As noted above, the GOP has plenty of passed plans, they just haven’t been forthcoming about “the replacement plan”. That means we are stuck with uncertainty, wonder, and what-ifs until the plan is on the table… and it also means the repeal has started before the conversation, which is causing a lot of the surrounding “fuss”. 20 million lives really are on the line, although to what extent really depends on what happens.
You can Help Save ObamaCare and Other Assistance Programs
Even if Trump follows through with his long-standing promise of “a great replacement plan”, key provisions of ObamaCare, Medicaid, and Medicare may still be on the chopping block in 2017.