Photo courtesy Healthcare.gov
There are 82 days left in the open enrollment period for Virginians seeking health insurance for 2017 under the Affordable Care Act, but whether that coverage will continue is an open question.
The program is better known as Obamacare, and about 422,000 Virginia residents had health insurance through the program for 2016. Open enrollment for 2017 began earlier this month, but President-elect Trump has said that on day one of his administration, he will ask Congress to “immediately deliver a full repeal of Obamacare.”
That may sound like a good move to many. The ACA has been subject to repeated criticisms over its existence, most recently in the waning days of the campaign after announcements regarding steep price increases for the coming year, though they would be allayed with subsidies.
So, where would a repeal leave people who have their health insurance through Obamacare? The topic has been covered recently by The Washington Post and Politico, but as with much of what’s to come on the political landscape, it’s still obscured by the campaign fog.
The Trump campaign website, donaldtrump.com, offers a glimpse of what the new administration wants in terms of a replacement, but few details. Broadly, they call for reforms that will “follow free market principles” and want a policy that “will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.”
A bit more specifically, the site calls for an elimination of the individual mandate, that everyone must be insured; modifying laws to allow insurance companies to sell across state lines; a full reduction of your health insurance premiums that you pay on your tax return; to work with states to ensure that anyone who wants insurance can afford it; encourage health savings accounts, making contributions tax-free and able to accumulate; require price transparency of healthcare providers; provide Medicaid block grants to states; and encourage the free market in the pharmaceutical industry: “Allowing consumers access to imported safe and dependable drugs from overseas will bring more options to consumers.”
The idea behind such private market initiatives is to boost competition and for consumers to have more skin in the game, which would in turn result in lower health care costs, says Peter Cunningham, a professor of health behavior and policy at Virginia Commonwealth University.
Legislatively, since Republicans will again control Congress, they can deny funding for Medicaid expansion. “There’s basically a lot they can do to gut the law,” says Cunningham.
But that raises a big question: How could you take away coverage from 11 million Americans and provide nothing in return? The answer: You probably couldn’t. “They probably realize it’s political suicide,” says Cunningham.
There are other factors to consider as well. For example, left unaddressed in Trump’s broad outline is another component of Obamacare, in which pay to providers is based on the value and quality of the care they provide, instead of the volume of patients seen, says Cunningham.
Another consideration is that the ACA has been in place for several years, and in addition to the insured, its other major stakeholders, doctors, hospitals, insurers, etc., are also heavily invested in the current system, Cunningham notes.
How will any reforms affect them? Will they take a huge financial hit if the administration and Congress uproot the program?
And what do you do with popular portions of the law — for example, the ability to have adult children up to age 26 provided coverage under your plan, and the requirement for insurers to provide coverage for preexisting conditions?
Cunningham says he can imagine a scenario in which changes are billed as repeal and replace, but may look like more of a reform of the current law.
There are also seeming contradictions to the Trump proposals. For example, if you do away with an individual mandate and still require insurers to cover the sickest and costliest in the population, how do you reign in costs? It’s complicated, and to come up with any meaningful replacement is going to be challenging, says Cunningham.
“It’s very easy to say repeal and replace, and that may sound good, but again, replace with what?”
So for now, people still need insurance, and the ACA is still in business. You can check out the plans yourself at HealthCare.gov, and you also can receive help navigating the site through several assistance programs. In Virginia, one resource is the Enroll Virginia Project, which has been reassuring people that plans are still available, and helping them to enroll, says Jill Hankin, director of the project.
You have until Dec. 15 to enroll or re-enroll for coverage to begin Jan. 1. Otherwise, you can enroll through Jan. 31, but coverage may not begin until March 1. Learn more about enrollment opportunities at the Enroll Virginia website, or call toll-free at 888-392-5132.
