No matter where you stand on the political spectrum, health care under the Affordable Care Act is going to change in the next few years. The Republican-led Congress has vowed to “repeal and replace” the health law known as Obamacare.
That has left many people anxious and confused about what will happen and when. So NPR’s Morning Edition asked listeners to post questions on Twitter and Facebook, and we will be answering some of them here and on the radio in the weeks ahead.
Many of the questions so far have to do with timing.
For example, Steva Stowell-Hardcastle of Lewisburg, Penn., says: “I’m confused about what parts of the ACA have been repealed and when those changes take place.”
First, despite social media headlines, nothing substantive has been changed in 2017. That’s because making these changes is harder than it looks.
In January, Republicans in Congress passed a budget resolution that called for major changes to the law to be made in a subsequent bill.
Even though that process would allow them to pass a bill without Democratic votes, they haven’t been able to agree on what those reforms should look like.
And there are several other obstacles.
First of all, they won’t be able to repeal everything in one go, which counters a lot of the rhetoric coming out of the election. And they would be limited in what parts of the law they can replace.
That said, the Trump Administration has taken some action, but no concrete changes – yet. In January, Trump signed an executive order calling for federal agencies to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the act” that would “impose a fiscal burden” on states, individuals, healthcare providers, and others in the health industry.
While that could be widely interpreted, so far the only federal action in response to that order has come from the IRS. The IRS says it will not strictly enforce the “individual mandate” that requires most Americans to have health insurance. The agency noted, however, the requirement is still law.
A related question comes from Kathryn Henry of Iowa City, Iowa. She asks “if it is repealed, what happens to people like me who currently have insurance through it and when?”
Both President Trump and GOP congressional leaders have insisted that they want a smooth transition from the current system to a new one, particularly for the 11 million or so people who purchased coverage on the federal or state health insurance exchanges since the law took effect.
“We don’t want to pull the rug out from under people while we’re replacing this law,” said House Speaker Paul Ryan, R-Wisc., in January. Trump has insisted that repealing the law and replacing it be done “essentially simultaneously,” so as not to leave people without insurance.
Unless something unexpected happens, people who purchased insurance for 2017 should be covered through the remainder of the year.
The bigger question is what happens in 2018. The uncertainty alone is prompting some insurers to pull out of the individual insurance market — the market in which people don’t get insurance through their employer. The individual market is the most affected by the health law.
For example, the insurance company Humana has already said it won’t participate in the health insurance exchanges next year, and the CEO of Aetna told reporters that his company might drop out, too. If Congress deadlocks over how to overhaul the health law, more insurance companies could follow suit.
Insurers were supposed to tell the federal government if they planned to participate in the insurance exchanges by May 3, but the Trump Administration has now given them until the end of June.
Got more questions about what’s happening to the ACA? I’ll be back next week with answers. Just tweet @MorningEdition using the hashtag #ACAchat.