One of the top legislative priorities under a Trump administration will be changing or repealing the Affordable Care Act (ACA), also known as Obamacare. This law is consequential to the diabetes community because it includes, among other things, a provision outlawing insurance companies from denying coverage based on preexisting conditions like diabetes.
Here’s an overview of what people are saying about the fate of the ACA:
President-Elect Donald Trump has called the ACA a disaster, and has vowed to repeal and replace it with a different plan. What that plan would entail is an open question. While Mr. Trump has said before that he would want the plan to cover preexisting conditions so there aren’t, in his words, “people dying in the streets,” his official position paper on health care does not mention preexisting conditions at all.
Donald Trump will be working with a Congress controlled by Republicans, as the GOP has won the majority of both the House of Representatives and the Senate in the 2016 elections. Republicans have repeatedly tried to repeal the ACA since its passage in 2009, so they will try to do so again under a Trump administration. In a Politico report, Senate Majority leader Mitch McConnell (Kentucky) said this week that repealing Obamacare was “pretty high on the agenda”.
However, scrapping Obamacare will probably not be a short process. That’s because Republicans did not gain a supermajority in the Senate which could prevent Democrats there from blocking efforts to alter Obamacare. Democrats could, in theory, filibuster to prevent action on most bills, and Republicans would need 60 votes to end a filibuster; if everyone voted along party lines, the filibuster would not be defeated. This means that, for the moment, Republicans can’t repeal ACA completely unless they put forth a plan that would appeal to at least some Senate Democrats.
This doesn’t mean that Republicans are stuck, however. They could choose to change portions of the ACA through a parliamentary procedure called reconciliation. Under these rules, Republicans could put some changes of the ACA into a budget bill and then pass it with a simple majority.
So what what would these changes look like? It turns out we probably have a road map. As a New York Times report concisely lays out, Republicans already passed a package of changes in 2015, only to have President Obama veto it. The Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015 would have eliminated subsidies to purchase health insurance for the middle class; tax penalties for those who choose not to buy health insurance; and taxes to fund the ACA. Such a move, if it were to pass, would likely cause the ACA to collapse, as it would eliminate incentives for healthier individuals to buy into the risk pool, leaving only those at high risk to contend with climbing prices. In the Politico report, McConnell did not commit to using reconciliation to change the ACA.
But let’s say somehow Republicans convince some Democrats to join with them in repealing the ACA, and there is no replacement plan in place. If that were the case, it seems unlikely that the provisions of such a bill could go into effect overnight without catastrophic economic consequences and court challenges. Instead, it would likely allow for some lead time. According to a Time report, the 2015 bill built in a two-year transition period to enact the changes, and Vice President-Elect Mike Pence has indicated that he would also want there to be transition time.
Presumably, the Trump administration would want to have a new plan in place before the ACA ceases to function. The billion-dollar question is whether such a plan would also cover preexisting conditions like diabetes. A second, and equally burning question would be whether, given the changes that have been proposed, that health insurance for preexisting conditions would be too expensive to obtain; the same criticism is also being leveled at the ACA, especially with a recent round of price hikes for premiums.
Insulin Nation will track the progress of any bill that may impact the ACA in the weeks and months ahead.
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