After seven years of attempts to repeal Obamacare in the House of Representatives, followed by a presidential campaign focused on repealing and replacing the law which was signed into place by former President Barack Obama, the Republican Party and President Trump failed with their first attempt at repealing the Affordable Car Act. Facing strong opposition across class and racial lines, and across the country, the Republican party chose to withdraw a bill which would have left more than 24 million people uninsured.
With President Trump now focusing his attentions on Syria and the tax code, the future of the ACA seems murky, which is worrying for the millions of people who rely on the law for their health insurance. The president has implied that the Republican party may simply wait for the healthcare law to implode under its own weight, while the Congressional Budget Office has contested that the health insurance marketplaces that the law relies on are robust and healthy.
If you are interested in the future of Obamacare, what should you be watching in the future?
Cost Sharing Reductions
There are two primary pieces of payments that the ACA assists with for low income people: first, the law helps pay for premiums, and second, it helps to pay for items like co-pays and deductibles. Under the Obama administration, lawmakers had sued to prevent these items from being paid. While avoiding temporary health care and paying these costs would not directly contribute to the law’s downfall, it might limit the amount that low income insured people are willing or able to use the insurance itself.
If they are not using the insurance, then they are less likely to be defenders of the health insurance bill itself. Most experts agree that it was public backlash which kept the ACA from being repealed when lawmakers took up the challenge in March.
As of this week, the Trump administration indicated that they would continue, at this time, to pay the cost-sharing subsidies that the House had previously been disputed, so this appears to be resolved for the time being.
June 21 Filings
The next big hurdle for the Affordable Care Act will be determining whether or not insurance companies will continue to sell policies in the various state marketplaces. Some insurance companies, like Humana, have already stated that they will be withdrawing from most of the markets where they sold insurance; other insurers, like Aetna, have said that they are concerned about the marketplaces, but have not indicated whether or not they will continue to operate in the marketplaces.
June 21st is only a preliminary filing date; an insurance company can file on that date, negotiate with the state, and ultimately decide not to offer insurance. But companies that do not file by June 21 are clearly indicating that they have no intention of offering insurance in the relevant states, which will begin to give both insured and lawmakers an idea of what the insurance landscape may look like in 2018.
Medicare-for-All?
Although this is normally a Democratic Party talking point, there have been some indications that the Trump administration would consider supporting a Medicare-for-All package. Due to loss aversion, many experts agree that repeal-and-replace will no longer be sufficient for many constituents, who are unwilling to lose their health insurance. Loss aversion also factors in for Republicans who fear losing their congressional seats if they allow their constituents to lose the health insurance provided by the Affordable Care Act without creating an actual better replacement.
Most other developed nations have some form of single payer health insurance. Christopher Ruddy is one of many friends and advisors of President Trump who has reportedly been urging the president to consider working with Democrats to develop a passable health care law formulated around single payer concepts. Most evidence shows that single-payer systems reduce fraud and waste, reduce health insurance costs, and provide excellent care with good results.
A private insurance marketplace remains, as private insurers sell supplemental policies, much like they currently do to Medicare A and B beneficiaries. They also allow for better cost comparisons, which can help create a better platform for competition.
President Trump appears to enjoy being unpredictable, states the New York Times, and so this approach may appeal to him, despite his own party being less than fond of the single-payer concept.
The path forward for Obamacare is unclear. If lawmakers simply refuse to fund certain provisions of the bill over time, it may be as effective as ultimately repealing the law. If insurance companies remain unwilling to work with states to negotiate reasonable rates for consumers, the marketplaces may find it difficult to thrive. But for now, those who have their insurance through the provisions of the Affordable Care Act appear to be safe for a while longer.