A resurgent Republican Party will repeal ‘Obamacare,’ possibly with chaotic results – especially in Black America.


WASHINGTON – Congressional Republicans are considering a “lightning-strike” rollback of the Affordable Care Act – “Obamacare” – early next year to kick off the Donald Trump era, but first they have to agree on a plan.

Signups for the “Obamacare” Healthcare.gov website have accelerated since Donald Trump was elected president. (RICHARD B. LEVINE/SIPA USA/TNS)
Signups for the “Obamacare” Healthcare.gov website have accelerated since Donald Trump was elected president.

Republicans won’t have much room for error to successfully repeal Obamacare, a top campaign promise of Trump and congressional Republicans.

Even if they delay the repeal to allow more time to come up with a replacement, there will be pressure to use the legislative maneuver to push through other top GOP priorities, such as defunding Planned Parenthood.

The Republican plan would take advantage of “reconciliation,” a budget-related mechanism to circumvent the 60-vote threshold in the Senate and prevent Democrats from being able to block legislation on their own. By striking early, the GOP could set itself up to invoke the same procedure again later in the year on a broader range of targets, including tax cuts.

Passing something in Trump’s first 100 days would allow Republicans to claim a big win early on, and conservatives are demanding the GOP deliver quickly.

Dramatic changes coming
“There is significant risk of chaos,” warned Ian Morrison, a health care consultant who advises health systems nationwide. “If they don’t get this right, a lot of people will suffer.”

Avoiding major instability has become a central focus for senior Republicans scrambling to plot a health care strategy. But it won’t be easy, given the sheer number of people who may be affected.

About 11 million Americans, most of whom get government subsidies to offset their insurance premiums, depend on insurance marketplaces created by the health law that Republicans have proposed eliminating.

Another approximately 75 million poor Americans are enrolled in either the Children’s Health Insurance Program (CHIP) or Medicaid, which would be scaled back in most GOP health plans.

Impact on Blacks
According to 2015 U.S. Department of Health and Human Services statistics, an estimated 6 in 10 uninsured African-Americans qualified for CHIP, Medicaid or lower costs on monthly premiums through Obamacare marketplaces.
•More than 2.3 million African-Americans ages 18-64 gained health insurance coverage since Obamacare was enacted, lowering the uninsured rate among African-Americans by 6.8 percentage points.
•More than 500,000 young Black adults between the ages of 19 and 26 who would have been uninsured got coverage under their parents’ plan.
•If all states expanded Medicaid coverage under the Act, 95 percent of eligible uninsured African-Americans might qualify for Medicaid, CHIP, or programs to help lower the cost of health insurance coverage in the marketplaces.

Moving too fast
“Any time a party has been out of power … there is an instinct to try to do everything as rapidly as possible and to do it in a way that satisfies their appetite for change,” said former Utah Gov. Mike Leavitt, who served as Health and Human Services secretary under President George W. Bush.

Across the country, hospitals, doctors, insurers and others are deeply anxious.

“Perhaps Congress can lead us in a direction where we fix the things that are wrong with the ACA, because there are many, and preserve what is good,” said Sheryl Skolnick, research director at investment bank Mizuho Securities USA.

“From where I sit, I think it’s a very risky bet.”

Several senior GOP senators in recent days have emphasized that they want to avoid turmoil.

“Congress will make sure that the transition is a smooth one for Americans,” said Sen. John Barrasso, R-Wyo., the leader of the Senate Republican Policy Committee. “People have already faced too much disruption in their health care due to Obamacare.”

Multiyear process?
To reduce potential chaos, congressional Republicans have been discussing a multistep, multiyear process for repealing and replacing the health law.

They would vote early next year on legislation that would scrap large parts of the law, including the unpopular insurance mandate and funding for insurance subsidies and for Medicaid expansions that 31 states have enacted.

That legislation would delay the effective date of the repeal for a year or two, however, giving Republicans time to develop an alternative.

While this “repeal-and-delay” strategy may not jeopardize coverage immediately for Americans who gained it through the health law, it could seriously destabilize insurance marketplaces.

Sicker than expected
Many insurers in the marketplaces have been losing money, in large part because consumers who signed up for coverage were sicker than anticipated.

Insurers remained in hopes that the marketplaces would be stabilized by the next administration.

But if the marketplaces are being eliminated, many insurers would likely reevaluate, according to industry officials and health care experts.

If insurers walk away, millions of consumers would be forced to switch plans or pay big premium hikes, reprising the kind of turmoil that occurred in 2013, but potentially on a larger scale.

Generally pleased
Although consumer frustration with premiums and other problems has intensified this year, polls show most marketplace users are satisfied. More than two-thirds rated their coverage as “excellent” or “good” in a nationwide survey this year by the nonprofit Kaiser Family Foundation.

Congressional Republicans have also attacked the current administration for providing financial assistance to low-income marketplace consumers to help them pay deductibles and co-pays, arguing that that money was not appropriated by Congress.

If the Trump administration stops those payments, as some conservatives have advocated, many more insurers would likely cancel their health plans. Whether they would return will depend on what kind of replacement Republicans ultimately develop.

No details
Trump transition officials have not detailed any of the new administration’s health care plans.

“This is an area that is very fraught and very difficult because the policy is complicated,” said Dean Rosen, who served as health care adviser to former Senate Majority Leader Bill Frist, R-Tenn.

“It is one thing when you are painting on a blank canvas. It is another when you are taking down someone’s version of the Mona Lisa and trying to put up something that you think is better.”

Noam N. Levey of the Tribune Washington Bureau and Steven T. Dennis and Billy House of Bloomberg News / TNS all contributed to this report.



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