Full Repeal or Partial? Providers and Patients Await Obamacare Legislation

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Affordable Care Act / Michael Havens

November 11, 2016; Wall Street Journal

In an interview with the Wall Street Journal last week, President-elect Donald Trump appeared to modify his election promise to ask Congress to fully repeal Obamacare on his first day in office, saying he would consider leaving some aspects of the law in place.

His remarks came after he met with President Barack Obama at the White House on Thursday, who urged him to reconsider the repeal. Trump specifically singled out the Affordable Care Act’s ban on denying insurance to people with pre-existing conditions and its allowing of children to remain on their parents’ insurance until age 26 as aspects of the current law that he would retain, saying, “I like those very much.”

Trump is not straying far from the Republican course in endorsing these ideas. Both have featured in various GOP healthcare plans in the past, including Paul Ryan’s 2015 “A Better Way” treatise. (NPQ’s Michael Wyland recently reported on clues to where Trump may be pulling his health policy legislation from, including the Republicans’ 2016 platform and Ryan’s agenda.)

The Washington Post criticized Trump’s potential plan to prohibit the denial of coverage to those with pre-existing conditions while removing the individual mandate, calling it unworkable “hokum.” (Fun fact: In February, Trump told CNN’s Anderson Cooper he liked the mandate, before launching into a word salad so dense it apparently deadened Cooper’s reactions, preventing him from following up.)

Improving aspects of Obamacare instead of repealing it is an avenue Trump might want to explore more thoroughly. In 2015, a poll of battleground state voters revealed the majority felt Congress should work on improving what the ACA had already implemented, including increasing healthcare cost transparency and lowering high prescription copayments, instead of wasting resources challenging it. This could also make changes easier for patients (remember them?) who have come to rely on and appreciate the security and better quality health care it has provided.

Over 20 million people have signed up for either private health insurance or Medicaid under the ACA, with 100,000 enrolling on the day after Trump’s election win. Understandably, since Trump hasn’t yet taken office and his repeal legislation has not yet been presented, neither Trump nor the Republican Party has put forward a detailed plan of how these people would be impacted if Obamacare is repealed in January, leaving many frightened and anxious about how they will maintain much needed protection and support.

Jessica Karabian, 32 and the mother of a three-year-old, has incurable breast cancer and relies on Medicare and a supplemental policy provided under the ACA for the care that is keeping her alive. She told the Philadelphia Inquirer last week that if her supplement were dropped as a result of Trump’s repeal, “I’m afraid this will give me even less time than I already have.”

Jean Sachs, CEO of the patient support and advocacy center Living Beyond Breast Cancer, added, “Women living with metastatic cancer are frantic and scared. So many of them couldn’t get insurance if they didn’t have the ACA. Trump had a lot of rhetoric, but now, what does that mean?”

Jay Wolfson, a senior associate dean at University of South Florida’s Morsani College of Medicine told the Sun Sentinel that he expected patients with serious illnesses will lose some of the benefits they gained through Obamacare, “As has always been the case in health care, the blunt end of the sword hits the patient first.”—Melinda Crosby