Can ObamaCare Be Repealed?


This week’s ObamaCare news roundup curated by Jane M. Orient, MD

Now that the Republicans control the House, the Senate, and the White House, there’s only one excuse for not keeping their oft-repeated promise to repeal the [Un]Affordable Care Act (ACA or ObamaCare): lack of 60 votes in the Senate to overcome a filibuster. Much could be done (and has been done) through Budget Reconciliation, and this time would not be vetoed. Obamacare’s tax hikes, Medicaid expansion, and insurance exchange subsidies could go. That would affect $2 trillion of spending over the next decade, writes Avik Roy, but partial repeal bill would not get rid of Obamacare’s tens of thousands of pages of insurance regulations, the regulations that are responsible for the law’s drastic premium hikes.

Things Trump could do immediately: He could loosen requirements, for instance by exempting more people from the individual mandate to buy insurance. He could cut off funds for outreach and enrollment assistance for ObamaCare plans. The Trump Justice Department could stop fighting the lawsuit the Republican House brought against the Obama administration, seeking to shut off subsidies, sticking the insurance plans with the bills. If the subsidies stop, insurance companies would have the right to drop out of the ObamaCare markets almost immediately, which could lead to the collapse of the exchanges.

But now that they will be responsible for consequences, Republicans worry about increasing the number of uninsured, and seem to have accepted the concept that “universal coverage” is the Holy Grail. They fear being blamed for kicking 22 million people out of their insurance plans, as calculated by the Congressional Budget Office (CBO), writes John Graham.

The majority of the newly insured, however, were enrolled in Medicaid. And likely two-thirds of those were eligible before ACA, but had not signed up, according to a study by Jonathan Gruber. Gruber’s results suggest that if the ACA were repealed, a lot fewer people would likely lose coverage than previously thought, writes Brian Blase. It also means that the federal government is paying much more for these enrollees than it would have without ACA.

While people worry about the effects of repeal, leaving ACA in place continues to do harm. Exchanges will collapse unless more young, healthy people buy. Why don’t they? Because they are being charged premiums that are up to four times the real cost of their insurance. “The young and the healthy must over pay, we are told, so that older, sicker people can under pay—with premiums well below the cost of their insurance,” writes John Goodman. “Why is that a good thing? I have searched…policy report after policy report and…have found no answer to that question.”

As premiums keep going up, so do subsidies. And since the government doesn’t have any money, these just add to the national debt. The CBO projects $568 billion in premium subsidies over 10 years, and this amount will rise if more people sign up.

The open enrollment season will be a fright, writes Sally Pipes. The exchanges will resemble a ghost town, and more than a million will find their plan has disappeared.

One working class American, whose mortgage was nearly paid off, had to take out a second 15-year mortgage to cover premiums plus the $6,900 IRS clawback of subsidies because he had earned a bonus at work.

Interestingly, people in poor health, supposedly the ones to benefit most from ACA, swung their votes to Trump.


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