Advertisement
  1. Health

Under President Trump, what's next for Obamacare?

Dr. Derrick Hamilton examines Mary Blair on Jan. 21, 2014, at the Breathitt County Family Health Center in Jackson, Ky. Blair had medical coverage through the state’s Medicaid expansion under the Affordable Care Act. President-elect Donald J. Trump has said he wants to repeal and replace the law.
Published Nov. 11, 2016

On the campaign trail, Donald J. Trump had strong words about President Barack Obama's signature policy.

"If we don't repeal and replace Obamacare, we will destroy American health care forever," he said at a rally earlier this month.

He will soon be able to take action.

Trump heads to Washington in January with Republican majorities in both the House and Senate. Experts say that gives the new president the power he needs to dismantle the controversial health care law.

What's Trump's beef with the Affordable Care Act?

He opposes the individual mandate, which requires uninsured people to purchase coverage or pay a tax penalty. The provision is central to the health law. Without it, healthy people would likely drop their plans, leaving insurance companies unable to pay for those who are sick.

Trump has also railed against the cost of coverage. Last month, federal health officials said premiums would increase 25 percent on average heading into the 2017 open enrollment period.

What would it take to unravel the law?

There are some actions Trump could take on his own. For example, he could drop the administration's appeal to a lawsuit filed by House Republicans — effectively terminating some subsidies for low-income consumers.

That would destabilize the marketplace, said Cynthia Cox, an associate director at the non-profit Kaiser Family Foundation. "The effect would be more insurers exiting the exchange markets," she said.

Trump could go further with the help of Congress.

A full repeal would require a filibuster-proof 60 votes in the Senate — nine more than the GOP won on Tuesday. But Senate Republicans would have enough votes to pass a so-called "budget reconciliation bill" that could choke off funding to key provisions of the law.

On Wednesday, House Speaker Paul Ryan reminded reporters that congressional Republicans were already able to "pass that legislation and put it on the president's desk." The bill he was referencing cut off funding for the premium subsidies that help make health plans affordable. Obama vetoed the proposal in January.

Does Trump have a specific replacement in mind?

Yes, health savings accounts.

"People would put money into a medical savings account, perhaps have their employer contribute to their medical savings account, and purchase high-deductible insurance policies that would cover them for catastrophes," said Marshall Kapp, director of the Center for Innovative Collaboration in Medicine & Law at Florida State University.

Trump also wants to let individuals deduct their health insurance premiums from their tax returns. He has said the proposal would provide "much better health care at a much less expensive cost." An analysis by the Commonwealth Fund found it could increase the federal deficit by $41 billion.

Other parts of Trump's plan call for the sale of insurance across state lines, as well as the creation of high-risk pools for individuals who have not had continuous coverage.

What would that mean for the 20 million people who gained coverage under the Affordable Care Act?

That's the big question.

Jay Wolfson, a University of South Florida health law expert, said uninsured people would still have resources available to them, including private insurance markets.

"Go back eight years," he said. "Where did (uninsured) people go when they needed health care? They went to the emergency rooms, they went to clinics. All of those things are still available."

To help ease the blow, Cox, of the Kaiser foundation, said pieces of the existing law would likely be phased out over time.

"They could repeal it in name only, keeping in mind that a replacement could take several years to implement," she said. "We could be looking at 2020, 2021 until a replacement is in place."

Could young adults remain on their parents' plans?

Trump wouldn't have to repeal all aspects of the Affordable Care Act. Wolfson doesn't expect Trump to tinker with the provision that lets young adults stay on their parents' plans until they are 26.

"A lot of young veterans don't have full VA benefits, so their parents put them on their plans," Wolfson said. "It is a sensible thing to do."

What about people with pre-existing conditions who were denied coverage before the ACA?

Trump has said he believes insurance companies should be required to cover people with pre-existing conditions. Insurance companies, however, have said such a mandate would be costly, especially if healthy people leave the marketplace.

Should people who get their insurance through Obamacare buy a plan for 2017?

Yes. The Affordable Care Act is still the law of the land, and people who choose not to purchase coverage remain subject to the tax penalty. This year's fine starts at $695 and increases with income.

On Wednesday, White House press secretary Josh Earnest said Obama wasn't giving up on his signature health policy.

"This administration is going to continue to make a strong case that people should go to healthcare.gov, consider the options that are available to them and sign up for health care," he said. "The vast majority of people who do will be able to purchase insurance for $75 a month or less."

Leah Barber-Heinz, Florida spokeswoman for the nonprofit Enroll America, said open enrollment would continue as scheduled throughout the state. The annual signup window runs through Jan. 31.

"Make sure you get your free and unbiased enrollment assistance as soon as possible," she said.

Contact Kathleen McGrory at kmcgrory@tampabay.com or (727) 893-8330. Follow @kmcgrory.

ALSO IN THIS SECTION

  1. FILE  - In this Aug. 28, 2019, file photo, a man exhales while smoking an e-cigarette in Portland, Maine. Walmart says it will stop selling electronic cigarettes at its namesake stores and Sam's Clubs following a string of illnesses and deaths related to vaping.  The nation's largest retailer said Friday, Sept. 20 that it will complete its exit from e-cigarettes after selling through current inventory. It cited growing federal, state and local regulatory complexity regarding vaping products. ROBERT F. BUKATY  |  AP
    The nation’s largest retailer said Friday that it will complete its exit from e-cigarettes after selling through current inventory.
  2. Erik Maltais took an unconventional path to becoming CEO of Immertec, a virtual reality company aimed at training physicians remotely. He dropped out of school as a teenager, served in Iraq in the Marine Corps and eventually found his way to Tampa. OCTAVIO JONES   |   TIMES  |  Times
    Software from Immertec can bring physicians into an operating room thousands of miles away.
  3. Homeowner Cheryl Murdoch, 59, explains the workings of the Philips Smart Mirror in her bathroom. Murdoch and her husband live in the Epperson neighborhood in Wesley Chapel, home of the Crystal Lagoon, where some residents are piloting new health technologies inside their homes. SCOTT KEELER  |   Times
    In Pasco’s Crystal Lagoon community, AdventHealth and Metro Development Group are testing in-home technology aimed at keeping people away from the hospital.
  4. Dr. Paul McRae was the first black chief of staff at Bayfront Medical Center in St. Petersburg. Dr. McRae died on September 13, 2019. He was photographed here in the Tampa Bay Times photo studio for the 2008 Dr. Carter G Woodson Museum's "Legends Honorees" gala. BOYZELL HOSEY  |  BOYZELL HOSEY  |  Times
    ‘His extraordinary example paved the way for so many others.’
  5. Michael Jenkins spent seven days at North Tampa Behavioral Health last July. Since then, he says his three children have been afraid he’ll leave and not come home. JOHN PENDYGRAFT   |   Times
    The patients have no choice, and the hospital is making millions.
  6. Samantha Perez takes a call for someone in need of counseling at the Crisis Center of Tampa Bay earlier this year. The center handles calls dealing with suicide, sexual assault, homelessness and other traumatic situations. They also do outreach and counseling, and operate Transcare, an ambulance service. JONES, OCTAVIO  |  Tampa Bay Times
    Florida’s mental health care system saves lives.
  7. The Florida Department of Health in Hillsborough County identified a positive case of hepatitis A in a food service worker at Hamburger Mary's in Ybor City on Oct. 22, 2018. [JOSH FIALLO | Times] JOSH FIALLO | TIMES  |  JOSH FIALLO | Times
    Slightly more than 200,000 people have been vaccinated this year — a huge jump from the 49,324 people vaccinated in all of 2018.
  8. FILE - In this Feb. 20, 2014, file photo, a patron exhales vapor from an e-cigarette at a store in New York. Under the Trump administration, former FDA commissioner Scott Gottlieb kicked off his tenure in 2017 with the goal of making cigarettes less addictive by drastically cutting nicotine levels. He also rebooted the agency’s effort to ban menthol flavoring in cigarettes. But those efforts have been largely eclipsed by the need to respond to an unexpected explosion in e-cigarette use by teens. AP
    Hundreds of people nationwide have come down with lung illness related to vaping.
  9. This May 2018, photo provided by Joseph Jenkins shows his son, Jay, in the emergency room of the Lexington Medical Center in Lexington, S.C. Jay Jenkins suffered acute respiratory failure and drifted into a coma, according to his medical records, after he says he vaped a product labeled as a smokable form of the cannabis extract CBD. Lab testing commissioned as part of an Associated Press investigation into CBD vapes showed the cartridge that Jenkins says he puffed contained a synthetic marijuana compound blamed for at least 11 deaths in Europe. JOSEPH JENKINS  |  AP
    The vapor that Jenkins inhaled didn’t relax him. After two puffs, he ended up in a coma.
  10. H. Lee Moffitt Cancer Center & Research Institute is the centerpiece of Project Arthur, an 800-acre corporate park that could include up 24 million square feet of office and industrial space on nearly 7,000 acres of what is now ranch land, but targeted for development in central Pasco. Times
    The H. Lee Moffitt facility is the centerpiece of an economic development effort in a proposed 800-acre corporate park.
Advertisement
Advertisement
Advertisement