“Obamacare is done.”
That was the glum prediction late Tuesday night from Democratic political consultant James Carville, longtime ally of Hillary Clinton, as he noted the electoral math propelling Republican Donald Trump to victory in the presidential contest.
Repealing the Affordable Care Act — or making severe changes to it — is expected to be on the front burner in Washington in January. Opposition to the 2010 health care law has united Republicans for years, and the party retained control of Congress on Tuesday as well as capturing the White House.
President-elect Trump too has blasted the President Barack Obama’s signature legislation and repeatedly vowed to repeal it.
“Obamacare is a disaster. You know it. We all know it,” Trump said last month. “We have to repeal it and replace it with something absolutely much less expensive.”
If the health care law is repealed, what would happen to the 20 million Americans — including hundreds of thousands of Georgians — who gained health insurance because of it? The national uninsured rate has hit an all-time low under the Affordable Care Act.
But any significant changes to Obamacare will likely cause people to lose that coverage, said Bill Custer, a health insurance expert at Georgia State University.
Trump’s victory also likely means that advocates calling for the state to expand its Medicaid program for poor Georgians face steeper odds than ever.
Medicaid provides health coverage to more than 2 million people across Georgia, mostly children, pregnant women, the elderly and the disabled. Expansion would add at least 500,000 or more enrollees, mostly single adults without children.
Georgia was one of 19 states not to expand its Medicaid program under the ACA, but recently some Republicans had warmed to the idea, and the Georgia Chamber of Commerce was promoting plans to expand coverage.
Repeal a priority on Capitol Hill
Repealing the law won’t be an easy proposition. Democrats will still have enough power in the Senate, through a filibuster, to block the 60 votes needed for a full repeal.
Republicans, though, could use fast-track budget authority to make major changes to the law, according to Kaiser Health News.
Custer at Georgia State said a wholesale repeal would not only strip 20 million people of coverage, but it would also remove the ban on insurers discriminating against people with pre-existing health conditions, such as diabetes or high blood pressure.
If Republicans want to keep the pre-existing condition provision, they would have to create new financial incentives for insurers to cover such people, he said.
Repeal also would kill the Obamacare health insurance exchanges — which have been criticized for high premium increases for 2017 — as well as end subsidies that help exchange users afford coverage. And it would end the current mandate for individuals and employers to have coverage, a requirement long criticized by Republicans.
Major changes to the law could push Georgia’s uninsured rate back above 20 percent, from the 13.9 percent mark currently, Custer said.
An Obamacare supporter, Cindy Zeldin of advocacy group Georgians for a Healthy Future, said that “we are entering an uncertain time for health care, and at the forefront of our minds are the millions of Americans whose health insurance and access to basic care hang in the balance.”
She added that, “It’s too soon to know precisely what policy changes will occur and what their impact will be, but advocacy at both the state and federal levels on behalf of Georgians who need access to quality, affordable health care has never been more important.”
If not Obamacare then what?
Trump has proposed a series of measures that he says will allow people to buy affordable health insurance policies outside the Obamacare exchanges, according to NPR.
Those include promoting tax-free health savings accounts that might help individuals save money to pay for medical costs, and allowing people to deduct the cost of their premiums on their personal income tax returns. Trump has said he also wants to allow insurers to sell policies across state lines to boost competition.
Modern Healthcare reported that with Trump in the White House, congressional Republicans would press hard to transform Medicare into a so-called premium support program, under which the government makes fixed per capita contributions and beneficiaries use those payments to get their care from either traditional Medicare or private plans.
Such a move would potentially expose seniors to higher out-of-pocket costs. The GOP platform includes that proposal, even though Trump repeatedly promised in the primaries to leave Medicare unchanged.
Even if Trump fails to repeal the law, he could easily destroy it from within by refusing to fund it through the budget process, Austin Frakt, a health economist who runs the blog The Incidental Economist, told NPR.
“The only thing stopping that is, it’s a big deal to throw millions of people off insurance without offering something in return,” Frakt said.