A big part of Candidate Trump’s platform was to “Repeal & Replace” the Affordable Care Act (ACA), commonly called Obamacare. President Trump now has pressure from both voters and elected officials to deliver on his promises, and judging from his comments over the last few weeks it sounds like he is going to make good. Unfortunately, this has many people worried that they could lose their health insurance. Before anyone gets too upset, there are some practical realities that are good to keep in mind when thinking about how a Repeal will affect the coverage that you have now.
First, ACA was signed into law in March of 2010. In 2010, only 26 of its 90 provisions went into effect, and the majority of the provisions were implemented over the following 4 years, with its final provision, the “Cadillac Tax”, scheduled for 2018. In other words, ACA is so massive, so complex, that it still isn’t fully implemented. If implementation takes 8 years, then unwinding it will absolutely not happen overnight.
Second, even President Trump concedes that there are parts of ACA that he would like to keep, which is why “Replace” was the other half of the “Repeal” rhetoric. One of the more popular parts of the ACA was the elimination of pre-existing conditions when applying for individual coverage. But this part of the law comes at a cost and will likely require that the unpopular-to-Republicans mandate to purchase insurance also be kept as part of “Replace”.
The ACA is incredibly complex and stretches across the individual, employer-sponsored and Medicare/Medicaid insurance marketplaces. There is no consensus amongst the Republicans about which parts of the law to keep. The process of settling on a final “Replace” law will take time. But even if a Repeal/Replace package was passed today it would require time for all parties (government, insurers, providers, employers, employees, individual policy holders) to adjust. Employees who are covered through an employer’s plan would keep their current plan for 2017 at a minimum, and likely won’t see significant changes until 2019, if at all. House Speaker Paul Ryan made it clear last week that no changes will be made effective immediately upon passage of the new law.
Lastly, please take the media reports and political announcements with a grain of salt. It’s quite easy to hold a press conference and announce the name of a package of bills to be passed – but that doesn’t mean they’ve been passed, and it certainly doesn’t mean they’ve been implemented. If there was ever a time where the old phrase “the devil is in the details” applies, it applies to the Repeal/Replace of the ACA. President Trump and Congress still have a lot of work to do.