The Future of Obamacare under President Trump

One of the central planks of Donald Trump’s presidential election campaign was a promise to abolish the Affordable Care Act(ACA), more commonly called Obamacare. His campaign website declares that “On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.” CongressionalRepublicans opposed Obamacare since its inception, but were stymied in their efforts to repeal it by President Obama’s veto of any such legislation. The new president probably will sign any such bill that arrives on his desk.

What Will Happen to Obamacare?

Congress is likely to launch 2017 with a bill that repeals elements of the ACA. In late 2015, it passed the reconciliation bill HR 3762, which would have reversed Medicaid expansion, premium subsidies, cost-sharing subsidies, the individual and employer mandates, reinsurance, risk corridors, risk adjustment, and many of the ACA taxes and funding mechanisms. This bill was vetoed by Obama but would face no such obstacle in Trump

After the president elect met Obama on November 10, he explained that he aims to retain some elements of the ACA, such as the provision for young adults to remain on their parents’ plans until they reach 26 and the prohibition on coverage bans due to pre-existing conditions. These provisions could not have been repealed under a reconciliation bill anyway.

How Long Would It Take?

Whatever repeal bill is introduced in early 2017, it probably won’t reach Trump’s desk until the summer of next year and, given that it takes a minimum of 18 months for the IRS to devise the kind of tax system Congress has suggested to fund the cost of coverage in the wake of Obamacare, subsidies and Medicaid expansion are likely to remain in place through the end of 2018.

What Might Replace Obamacare?

The House Republicans’ healthcare reform proposalA Better Way, published in June 2016, indicates what a GOP alternative to Obamacare might look like. There are several key planks, at least some of which would attract a level of bipartisan support:

  • Making states (rather than federal government) largely responsible for regulatory control of health insurance.
  • Making it easier to access HSAs, raising contribution limits to match the maximum out-of-pocket on the associated HDHP, and broadening the parameters relating to the costs that can be reimbursed under the HSA.
  • Refundable tax credits to give those without employer-sponsored insurance access to health insurance.
  • Ceilings on the totalemployer-sponsored health insurance premiums that can be pre-tax.
  • A focus on health insurance across state lines.
  • Medical liability reform.
  • Continuous coverage protection to allow people to switch plans without medical underwriting, as long as they maintain continuous coverage.
  • A 5:1 ratio for premiums based on age to replace the current 3:1 ratio.
  • Federal funding for high-risk pools. High risk pools existed in most states prior to 2014, but have largely been dissolved since coverage became guaranteed issue under the ACA.
  • A one-time open enrollment period instead of an annual enrollment period.

States could choose whether they opt for a per-capita allotment or block-grant funding for Medicaid.

It is still too soon to predict what the health insurance market will look like in a few years. One thing is certain, however: The new uncertainty about the future of health insurance is already causing anxiety for many enrolled in Obamacare.


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