Indeed, after initial indications Republicans might push to have President Donald Trump sign a repeal plan his first day in office, it’s now clear that replacing some pieces of Obamacare will take weeks or months or even longer.
For now, the more than 480,000 Georgians with Obamacare have no clue what will become of their health coverage. Will they keep the insurance they have? If not, will they have access to another kind of coverage? Will it be affordable? Will it cover the same treatments, medications and other benefits that Obamacare offers? Fewer? More?
Short answer: no one knows — including Congress.
The GOP has enough votes in the Senate to kill the most substantial parts of the health law without the help of Democrats. But some Republicans, including those from states that have expanded Medicaid under the law, have raised concerns about rushing to dismantle it without having a replacement at the ready.
Health providers, insurers and other experts have warned such a move could devastate the nation’s individual insurance market. An estimated 18 million people would lose their coverage in the first year alone under that scenario, the nonpartisan Congressional Budget Office recently estimated.
“(Republicans) are in a tight spot trying to figure out what they can do to repeal and wouldn’t disrupt the market,” said Bill Custer, a health care expert at Georgia State University.
The GOP has yet to agree on a timeline to repeal the law, much less how and when to go about replacing it with something else or — perhaps most important — how to pay for that something else.
Four committees are working on legislation that will collectively repeal major elements of Obamacare, and GOP lawmakers are talking behind closed doors about replacement options.
Meanwhile, President Trump has said he wants to cover more Americans at less cost and is constructing his own replacement plan — outside of discussions with congressional Republicans.
The government can spend less and cover fewer people; but spending less and covering more people is trickier, said Larry Levitt, a health policy analyst with the nonprofit Kaiser Family Foundation.
There are so many moving pieces, it “makes it hard to even guess at how it’s going to play out,” Levitt said.
Alex Dang, owner of All Star Nail, at his shop in Atlanta in January. (Henry Taylor / email@example.com)
‘I’m very scared for my illness’
The stakes couldn’t be higher for Georgians who count on the Affordable Care Act for their health coverage.
About 85 percent of people with Obamacare in the state receive tax credits that lower their premiums. Without them, many wouldn’t be able to afford coverage at all.
Alex Dang, who owns a nail salon in Atlanta, receives a tax credit and pays $432 a month for the insurance that enables him to keep his diabetes in check. The father of two can’t imagine what he’d pay without Obamacare, if he could buy coverage at all.
Dang, 41, said he can’t afford to make paying for health insurance his No. 1 priority. Putting food on his family’s table comes first. Obamacare enables him to do both.
“I’m very, very worried,” he said of the uncertainty in Washington. “I’m very scared for my illness.”
Nationwide, an estimated 32 million Americans could lose their insurance in the next decade if Obamacare is repealed and not replaced.
That’s become a rallying point for Democrats on Capitol Hill who are generally fans of Barack Obama’s signature domestic achievement.
“It’s against our values to deprive 30 million people, to kick them off their access to the health care system, so we’ll be fighting that,” said U.S. Rep. Hank Johnson, D-Lithonia.
‘The American people deserve this’
Where Democrats differ is whether to help Republicans as they draw up a replacement plan. Many believe the GOP undermined Obamacare at every turn and don’t deserve any help.
“It will be up to Republicans to put together a plan,” said Johnson, who said he would support such a plan only if it improves upon Obama’s landmark law.
Other Democrats, such as U.S. Rep. David Scott of Atlanta, are more open to negotiating a replacement if it checks off certain boxes, including covering people with pre-existing conditions and allowing young people under 26 to stay on their parents’ insurance.
“We’ve got to make sure that all the I’s are dotted and the T’s are crossed,” Scott said. “The American people deserve this, and I don’t want any … people who would be directly impacted to lose any of their health care.”
GOP leaders have repeatedly said they have no intention of “pulling the rug” out from under people with Obamacare coverage.
Georgia Congressman Tom Price, Trump’s nominee for secretary of health and human services, said during a recent Senate confirmation hearing that he wants “to make certain every American has access to the highest quality of care.”
“There’s been a lot of talk about, about individuals losing health coverage,” Price said. “That is not our goal, nor is it our desire, nor is it our plan.”
‘Then you have a revolt’
Some Georgians will be pleasedto see the health law torn down.
Weltner, 64, saw her monthly premium skyrocket when she was forced under Obamacare to get a new, more expensive plan that included benefits she didn’t need. Then she moved with her husband to rural Georgia, where premiums are generally much higher than in urban areas.
She now pays $1,100 per month. Before the health law, insurance cost her $289 a month. Sure, it was a catastrophic plan with a $10,000 deductible, but that was her choice.
“It really is a tax,” said Weltner, who owns a public relations firm. “I’m taxed $1,100 a month, and I’m forced to buy a product I don’t want.”
The intent of the law may have been admirable, she said, “but when you take away freedom and personal choice and make people feel like they’re being dictated to and the expectations are not met, then you have a revolt.”
Many Obamacare plans also have such high deductibles – upward of $6,000 in some cases – people put off care because they can’t afford to pay that much out of their own pockets.
‘High deductibles crushing people’
That’s especially true in many rural areas where only one insurer is now offering Obamacare plans because competitors left the market.
“We’re seeing that high deductibles are just crushing people,” said Scott Hill, CEO of Columbus Regional Health in west Georgia.
The health system, Hill said, has seen a jump in bad debt from people who have insurance but can’t afford to pay their deductibles.
A patient may owe $5,000 even after their insurance pays up. Maybe they can set up a payment plan; maybe they can’t, he said.
The Affordable Care Act has been a blessing for a lot of people, but it has also made insurance close to unaffordable for many middle-class families who make too much to qualify for tax credits, said Russ Childers, an insurance broker in Americus.
Childers said he worked with a couple in their early 60s who made about $50,000 a year, too much for a tax credit. Their monthly premium was $2,200.
From a middle class perspective, people think, “I work hard. I earn money. I can afford a house. I can afford a car. I can’t afford insurance, and that’s something that is unacceptable,” Childers said.
‘The system is going to collapse’
There is broad agreement among Republicans that any Obamacare replacement should be a free-market system that focuses on mandates and incentives — not penalties.
Republicans also increasingly seem to favor a piecemeal approach rather than passing one or two mammoth bills like the Affordable Care Act.
But one big sticking point for the party is timing.
Repealing without having a replacement plan in place could spur insurers to flee the insurance exchanges, causing a market collapse. But waiting to repeal could take months — a delay many Republicans are keen to avoid since it runs counter to their campaign promises to voters.
Several Georgia delegation members said they approved of moving ahead with a repeal vote soon.
“I am because I know what’s happening right now behind the scenes, and that’s an active conversation about the replacement pieces,” said Republican U.S. Sen. David Perdue.
“I will tell you, if we don’t repeal the bill, the system is going to collapse anyway,” said U.S. Rep. Austin Scott, R-Tifton.
‘Get something done now’
Republican U.S. Sen. Johnny Isakson voted earlier this month in favor of the budget bill that paved the way for killing the health law.
But the three-term senator in recent weeks has also cautioned against moving too quickly. He warned in a speech on the Senate floor that repealing the law without a replacement plan would be an “unacceptable solution.”
More than a dozen GOP plans are floating around Capitol Hill, including one authored by Tom Price. Lawmakers are also eager to see the details of Trump’s plan before committing to any other legislation.
Trump said during his ABC interview last week it would be easier for Republicans to sit back and just let Obamacare “explode.”
“But the right thing to do is to get something done now,” he said. “I want to make sure that nobody’s dying on the streets when I’m president.”