During the 2016 campaign, a stumping candidate Trump often said he will “repeal and replace Obamacare.”
Since winning, the president-elect’s take on the Affordable Care Act seems to have softened. Donald Trump has said he might try to preserve some aspects of Obamacare including medical coverage for people with pre-existing conditions and for adult children living with their parents.
For years, Bernice Geels, who owns a coffee house in Denver with her husband, couldn’t get health insurance. Now she’s waiting to see what potential changes to health coverage will mean for her down the road. Before the ACA, insurers wouldn’t cover her because of a pre-existing neck injury.
“Obamacare did me very well, despite [that] I had to pay very high premiums,” Geels said. “I’m thankful to have it. At least I was able to get it.”
Geels was paying $600 a month for coverage through Humana, but the provider dropped out of the state’s health exchange, Connect for Health Colorado. Now Geels is scrambling to find new insurance. She qualifies for reduced rates with a federal tax subsidy. All the same, she calls the tumultuous changes in insurance “crazy.”
“I've got great concerns with health insurance in general, it's outrageous,” Geels said. “I don't know what President-elect Trump plans on doing, but it's chaotic.”
Her insurance broker, Tina Ledesma, said about half her 600 clients share those concerns. “There’s nothing we can really do, we kind of just have to take it day by day,” she said.
Michele Lueck, CEO of the non-partisan Colorado Health Institute, echoes what both Geels and Ledesma said, “there’s a tremendous amount of uncertainty.”
Obamacare cut the state’s uninsured rate to a historic low, below 7 percent. Roughly 450,000 people gained insurance through Obamacare, mostly through the expansion of Medicaid. According to an analysis by CHI, the expansion population reached 289,000 by June 2015 and is set to be about 363,000 by June 2017. Another 164,000 people got insurance through the state’s exchange, many receiving federal subsidies to help pay for insurance.
Now, Lueck noted, those federal policies could be undone.
“That's largely viewed as a good thing to have people insured in some way shape or form,” Lueck said. “So you'd hate to see that being reversed in any meaningful way.”
The big questions ahead for Lueck include what happens to federal payments and to state Medicaid programs? What happens to subsidies for people like Bernice Geels, to help them afford insurance? What happens to state insurance marketplaces?
Amy Stephens, a former Republican state lawmaker and current head of government affairs for the Denver law firm Dentons, doesn’t think “now is the time to panic or be concerned in terms of changes coming tomorrow.”
“Quickly, I think, in terms of Washington D.C., is a relative term.”
In coming weeks and months, Stephens said, a plan will emerge that gives states more power to set health policy. She thinks it’ll ease the financial burden of Obamacare and help lower costs for consumers. She said Republicans will likely favor approaches “to try to get rid of a lot of regs and taxes that are burdening businesses.”
“You had a bridge in, you’re going to have to have a bridge out,” Stephens said. “I believe and I support the bridge out and I think that there are ways to phase in, I think, a lot of reforms.”
Colorado might fare well under potential changes because, unlike many states, it set up its own health insurance exchange. One possible federal reform might allow carriers to sell insurance across state lines, which Stephens thinks could help lower costs and give consumers more choice. Colorado “would probably be very well set up,” under possible changes, she said.
Stephens thinks the popular guarantee to cover pre-existing conditions will stay, but the requirement to buy insurance, might go. Gov. John Hickenlooper, a Democrat, suspects Republicans will try to keep parts of the ACA.
“I think just immediately, I mean legally, they can't throw out all the Affordable Care Act on a whim,” Hickenlooper said on Colorado Matters, adding that the state is prepared to adjust, despite the unknowns.
“We will try to keep as many people insured as possible,” he said.
Kevin Patterson, CEO of Connect for Health Colorado, the state’s exchange, said the election of Trump and a Congress that may try to dismantle Obamacare changes nothing for those buying 2017 insurance through open enrollment. Coverage under 2017 plans purchased will continue for people through next year, despite any potential changes at the federal level. Consumers “should go ahead, sign up, get that coverage set,” Patterson said.
When asked about what changes might be in store for 2018, Patterson didn’t know, saying his “crystal ball kind of fell off the table.”
“I might have to send it in for repairs before I can answer that question,” he said.
Health insurance broker and ColoradoHealth.com president Tom Crennen expects any major changes from Washington to take time. He said the ACA “took about three years before it even started getting going, so it seems hard to believe that [repealing and replacing] it will just happen overnight.”
Bernice Geels hopes she can afford to stay insured. The plan she found will save her money. Beyond that, she has one tip for President-elect Trump: include coverage of pre-existing conditions. Geels’ sister had cancer, but is in remission now. Still, her sister “couldn't get health insurance before Obamacare passed,” she said. “You have to insure pre-existing.”
Geels said she’d love better, more affordable healthcare under the new administration, but she isn’t holding her breath.