Dr. Elisa Melendez-Eisman, the medical director of Clinica Tepeyac, with a patient.

(Courtesy Clinica Tepeyac)

Nearly half a million Coloradans have gotten health insurance because of the Affordable Care Act, also known as Obamacare, and more are signing up now, during the annual open enrollment period. The future of the act -- and the health insurance coverage it provides -- is uncertain, though, with Republicans in charge of both houses of Congress and soon the White House.

Vice President-elect Mike Pence said Tuesday, "The president-elect’s made it very clear. He wants the Congress when they convene in early January to take up the task of repealing and replacing Obamacare first."

Republicans haven't announced one, definitive plan to replace the law, but they have proposed several ideas. Julie Rovner discussed those options with Colorado Matters host Ryan Warner. Rovner is a senior correspondent for Kaiser Health News, a nonprofit news service focused on health policy, and covered health policy for NPR for 16 years. She also wrote the reference book "Health Care Politics and Policy A-Z."

Rovner on the history of the "individual mandate" -- one of the parts of the ACA that Republicans most want to get rid of -- that requires consumers to have health insurance or pay a tax penalty:

"It emerged first in the late-80s from some Republican health policy wonks. It was adopted by Republicans [in 1993] as an alternative to then-President Clinton's employer mandate, and it became law for the first time in Massachusetts under then-Governor [Republican] Mitt Romney in 2006."

Rovner on whether Republicans can repeal the law outright: 

"No, actually. They can make a mess of it. They can repeal big chunks of it. They can repeal the popular parts of it. But to repeal it entirely would require the same 60 votes the Democrats needed to pass it in the first place.

"What the Republicans can do instead is use this budget procedure, which allows them to avoid a filibuster in the Senate and pass with 51 votes. The problem with that everything in that bill has to be budget related. It has to either add to, or subtract from the federal deficit. So all of the provisions of the law that effect states -- things like impacting the state insurance markets -- those would not be allowed to be included in that budget bill. They'd have to either do that separately or later, or with some [replacement] bill. So it's a bit of a tightrope the Republicans are facing." 

Rovner on popular parts of Obamacare that Republicans might preserve:

"Covering people up to age 26 is easy and everybody already agreed on that. It was something that Mitt Romney ran on. I've heard some Republicans recently saying that it would cost billions of dollars. It doesn't cost billions of dollars. In fact, one of the odd things about letting kids up to 26 stay on their parents' plans is that it keeps those kids out of the individual market where they might help bring down the premiums because they are the one and healthy ones. But that's fairly diminimis."

"Pre-existing conditions -- that's a different issue. ... If you're going to let people who are sick into the pool, you need some mechanism to get healthy people in. Either a mandate or continuous coverage requirement. ... Otherwise only the sick people will buy insurance and it won't be financially viable."

Rovner on Republicans' call to let insurers sell plans across state lines:

"This proposal came around in the early 2000s. And it couldn't even get out of a House committee, because the insurance industry is mystified by it. State regulators are mystified by it. Why you, in one state, want to buy a plan in another state when most plans have these narrow networks. I'm here in Washington, D.C. If I bought a plan in Colorado, it would probably only cover Colorado physicians and hospitals.

"The other thing is in fact this was made legal to some extent in the Affordable Care Act because they were encouraging states that bordered each other to perhaps enter into some kind of a compact where there would be some kind of regulatory harmony so you could buy [plans across state lines]. ... But it was a plan that didn't make a whole lot of sense 15 years ago. And it seems to make even less sense now."