After years of railing against the Affordable Care Act, also known as Obamacare, Congressional opponents and the President-elect are now poised to eliminate it. Since its passage six years ago, opponents have argued to “repeal and replace” the law, but that has turned out to be merely a slogan, devoid of substance.
Opponents have no agreement on their plan to replace the ACA.
As imperfect as it is, the ACA did make major strides toward the goal of universal health coverage. Nearly 20 million Americans have health insurance because of the ACA, according to the Department of Health and Human Services. That includes about 10 million people who gained coverage through the expansion of Medicaid and another 10 million who buy insurance on the Obamacare exchanges or are young adults covered through their parents’ insurance. Here in New York, federal data show that the uninsured rate has fallen by 40 percent since the Affordable Care Act (ACA) was enacted in 2010. There are now over 3 million New Yorkers who obtain their coverage through programs provided under the ACA.
In addition, the number of people who have trouble paying their medical bills has plummeted in the last five years as more people have gained health insurance through the Affordable Care Act and gotten jobs as the economy has improved.
A report from the National Center for Health Statistics showed that the number of people whose families are struggling to pay medical bills dropped by 13 million, or one-fifth of the total, in the last five years. That’s good news; one of the biggest reasons why people go into bankruptcy is due to unpaid medical bills. The more coverage there is, the less likely such bankruptcies will occur.
That’s not to say that the law has been a complete success. There are still millions without health insurance, residing primarily in the South and the Southwest. Those people tend to be poor and live in Republican-leaning states, where opposition to the ACA has been highest.
Moreover, the ACA – which was based upon a law originally designed in the Massachusetts – has run into structural problems. Some health insurance companies are pulling out due to their purported inability to make enough money to cover the law’s costs and others are sharply raising prices. In New York City, for example, rates for a benchmark plan could go up by an average of 16 percent. Thus, without changes, unless the marketplaces stabilize, the drop in the uninsured rate could have stalled or even reversed.
Fixes were needed, but now the Congress and the President-elect will radically change the program.
In addition, the new Congressional leadership reportedly will be seeking to overhaul the nation’s Medicare program – the health insurance for those over the age of 65. And they are planning changes to the nation’s Medicaid program, which provides coverage for the poor.
Ironically, the Medicare changes under discussion could transform that program into something that looks more like the Affordable Care Act, a program that supplies a defined set of benefits and would offer subsidies for participants to purchase health care directly from insurance companies. There is also discussion to raise the Medicare eligibility age to rise to 67.
Any changes to Medicare and the health care law would be far-reaching, affecting some 55 million American seniors.
Despite the massive uncertainties and the potential enormous impacts, the Congress may send to President Trump a “repeal” bill in January that lays out at least a two-year timeline for changing the law.
While Washington cavalierly debates health coverage for tens of millions of Americans, the changes could have real impacts in New York. If the feds cut back on its support for the Medicaid program, how will the state make up the difference? If the ACA is fully repealed how will hospitals and other providers care for New Yorkers lacking health insurance?
After years of complaining about the federal law opponents now have a choice – replace the law with something better, or get rid of coverage for millions of Americans.