President-elect Donald Trump might be able to pick apart Barack Obama’s health reform without signing any legislation. All he has to do is remind potential insurance customers that they’re buying a product that soon might not exist.
Trump has promised that one of his first acts will be to repeal and replace the law, which is in the middle of signing up customers for next year. If insurance shoppers stay away, that could further destabilize the markets for coverage, where people are already seeing higher prices and fewer choices in many regions.
“It’s possible that some people are going to say, ‘Why bother to sign up? I’ll wait and see what the new one is,’” said Michael Neidorff, chief executive officer of health insurer Centene Corp.
With about two months to go before it hands over the White House — and potentially Obamacare’s fate — to Trump, the Obama administration is making a final push to get people into the program.
“This is the opportunity for them to come in and find affordable quality coverage,” Health and Human Services Secretary Sylvia Mathews Burwell said Thursday during a televised interview with Fox 5 in New York. As for the politics of repeal, she added “I don’t think people want to go back to a place where 20 million Americans lose health insurance.”
Republican Plans
Speaker of the House Paul Ryan, a Republican from Wisconsin, has put forth a plan that would keep a large role for government in health care, including — as Obamacare does now — tax credits to help people buy coverage. However, it would eliminate much of the expansion of Medicaid, raising the number of uninsured by about 4 million by 2026, according to an August report by the Center for Health and Economy.
The threat of repeal could put pressure on Democrats to come to the table and negotiate changes to the law or a limited pull-back with Republicans, who will continue to control both houses of Congress. Even with a repeal, it’s unlikely that people who sign up this year would lose coverage immediately.
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“Clearly we don’t want to do any harm to people already in the system,” said Senator Roger Wicker of Mississippi, the chairman of the National Republican Senatorial Committee. Senate Finance Committee Chairman Orrin Hatch, a Utah Republican, said his party wants to “work toward replacing Obamacare with common-sense reforms that will lower costs and increase choice.”
Wicker said he doesn’t think that Republicans will need to use a legislative process called budget reconciliation, which would let them circumvent a Democratic filibuster in the Senate. He said he’s hoping the parties can reach a consensus on changes instead.
Move for Repeal
That said, there’s little question it’s a priority for Republicans. Mitch McConnell, the Senate Majority Leader, said Wednesday that he “would be shocked” if Congress didn’t try to repeal the law. “The sooner we can go in a different direction the better,” he said.
There are already predictions that the law will struggle to attract additional customers for next year — even without the threat of Trump. Deep Banerjee, an analyst at S&P Global Ratings, predicted in October that enrollment could decline as much as 8 percent compared with 2016, or rise as much as 4 percent. The U.S. last month predicted that about 13.8 million people would sign up.
On Thursday, Banerjee said it’s increasingly likely that sign-ups will end up at the low end of his estimate.
“The decline could be greater than our downside if the uncertainties around the future of the exchanges completely overshadow the current open enrollment season,” Banerjee and his colleagues said in a research report.
Uncertain Future
For people who rely on Obamacare for insurance already, the uncertainty for the program under Trump is unnerving. Mary Hamel, a 55-year-old who works at a Minnesota nonprofit, buys health insurance through the law. She has epilepsy and worries about losing access to coverage.
“I feel so vulnerable,” Hamel, who says she voted for Democratic candidate Hillary Clinton, said in a phone interview. “Insurance companies may give me the boot.”
The Obama administration plans to keep pushing enrollment under the ACA, and its allies have promised not to let the law go down without a fight.
“We’re going to lead an enormous fight to make sure that the huge number of people who are benefiting from the ACA don’t lose those benefits,” said Ron Pollack, executive director of Families USA, which helped push enactment of the law. The election “may have an effect on the big fight that is about to occur, but it does not, in any way, affect the ability for people to gain coverage through the enrollment process now.”
Limited Time
Time is short. Many large health insurers have pulled back from the law, and insurers typically start planning their policies many months ahead of time. Anthem Inc., which offers Affordable Care Act coverage in more than a dozen states, has said it’ll decide where to continue selling plans for 2018 around the middle of next year.
Health insurance CEOs said they’re betting Trump and congressional Republicans won’t end coverage right away. Centene’s Neidorff is betting on a transition period, and Mario Molina, CEO of Molina Healthcare Inc., said he thinks Republicans will keep a large role for private companies like his in Medicaid and insurance for individuals who don’t get coverage through work.
“This guy is a populist president. He got elected by the people,” Molina said. “And a lot of them, especially those people in the South and the Rust Belt states that voted for him, they need health care.”