The fate of Obamacare

Nov. 28, 2016
The debate about repealing and replacing the Affordable Care Act (ACA), also commonly known as Obamacare, has raged since the controversial legislation was signed into law in 2010. Since then Republicans in Congress have voted to repeal all or parts of the law more than 60 times ― efforts that have died in the Senate or been vetoed by President Obama. “After nearly a decade of premium increases, Obamacare is sending premiums to new heights and despite all of the efforts folks must endure to obtain coverage, they often face further obstacles to gain access to care,” said Rep. Tom Price, MD (R-Ga.) — who will be nominated Secretary of the U.S. Department of Health and Human Services in the new Administration — in an interview with the Academy’s Dermatology World magazine. “Obamacare can’t be fixed; we must fully repeal it so we can start over with a new approach.”

However, now that Republican President-elect Donald Trump is headed to the White House, the controversial piece of legislation could be on its way out. Throughout his campaign, President-elect Trump has vowed to sign legislation that would fully repeal the ACA, and just recently, Vice President-elect Mike Pence has confirmed that full repeal will be one of the Administration’s top priorities, stating, “Decisions have been made by the president-elect that he wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare with the kind of free-market solutions that he campaigned on.”

In terms of replacement options, “Republicans would preserve some insurance market protections,” said Eric Cragun, senior director of The Advisory Board’s health care policy division, in a recent webinar. “They would likely cap tax exclusions for employers and expand HSAs.” Indeed, in a recent interview with the Wall Street Journal, the President-elect indicated that he would be open to keeping two provisions of the current law: the provision that would not allow insurance companies to deny coverage to patients with pre-existing conditions, and the provision that allows children to remain on their parents’ health plans through age 26.

Yet, repealing the law will require 60 votes in favor of repeal in the Senate and Republicans currently hold only 51 seats. Congress could remove certain provisions under the ACA through a process called budget reconciliation, however, “It’s a classic example of: it’s much easier said than done,” said Piper Su, vice president at McDermott Consulting, in a recent Advisory Board webinar. According to Su, the ACA provisions that could be repealed through the budget process would have to be significantly tied to federal fiscal policy. “The provision would have to have a big budget impact. It’s a fairly complicated maneuver, but they’d have to try because it’s hard to envision a world where they would get 60 votes to do an overall repeal.”

Read more about how the new Congress and Administration are likely to address these issues in the October issue of Dermatology World.