Each morning I take three pills, all of which I need to stay alive. I get my health insurance through the US Affordable Care Act — without it, I’d be spending upwards of $US500 ($662) on prescription medication each month.
Illustration: Jim Cooke
When Donald Trump became the President-elect of the United States, a surge of fear shot through my body. Trump has promised to repeal the Affordable Care Act, an action that could deny anyone in America who requires ongoing medical treatment access to life-saving medication. While Trump’s pledge to eliminate Obamacare within his first 100 days in office is going to be difficult if not impossible to fulfil, it’s very possible that Trump and his Republican cohort would, at least, gut what’s left of the Affordable Care Act such that it’s basically unrecognisable. Considering how frequently Trump contradicts himself, we find ourselves in limbo, waiting.
Without insurance, anyone in America who regularly takes prescription medication — especially anything without a generic version — would be screwed. And while some of the 22 million Americans currently insured through the Affordable Care Act might find insurance in a new system, others may not. Obamacare includes important provisions, like making it illegal to deny coverage to people with preexisting conditions.
An informal Twitter survey illustrates how expensive losing health insurance would be for many Americans:
$146 vs $3.27 monthly ????
— gabriela barkho (@gabrielabarkho) November 10, 2016
— Commuter Pigeon (@john_frogurty) November 10, 2016
While these fears are justified, the question remains: Will Americans really lose their health insurance? In his first 100 days, here’s what Trump says he’ll do to the US health care system:
Repeal and Replace Obamacare Act. Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds. Reforms will also include cutting the red tape at the FDA: there are over 4,000 drugs awaiting approval, and we especially want to speed the approval of life-saving medications.
Dr Mario Molina, the CEO of Molina Healthcare, told Reuters that because enrolment for 2017 coverage opened on November 1, “it would be legally difficult for Trump to cancel them before the one-year contracts run out”.
“Any changes they make will have to be on a prospective basis to begin in 2018,” Dr Molina said.
Completely repealing Obamacare won’t be easy. You can’t instantly take away the medical coverage of 22 million Americans, especially without a 60-vote majority in the Senate. A whopping 96 per cent of households are beneficiaries of some sort of US government assistance, including social security, tax breaks and, yes, health care benefits. Republicans could face a huge backlash if they take away voters’ health care without replacing it with another system. So for all the bluster during campaign season, the politics of repeal might be impossible, too.
Still, Trump could effectively dismantle much of the Affordable Care Act using a process called budget reconciliation. As Reuters pointed out, “That would allow him to eliminate funding for the income-based subsidies that make the new insurance plans affordable, or cut the money providing expanded Medicaid benefits in 31 states.”
Last year, US Republicans attempted to pass the “Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015“, which would have eliminated Medicaid coverage for those living close to or below the poverty line, as well as tax penalties for the uninsured. The bill passed in the House and the Senate, but President Obama vetoed it. If Trump were to gut the Affordable Care Act, introducing similar legislation would be the way to go, which could have a devastating impact on America’s poorest people.
The US Department of Health and Human Services reported in 2015 that Obamacare not only improved patient safety — hospital-acquired illnesses have declined 17 per cent since 2011 — but also decreased the number of hospital admissions by 150,000. Although the Affordable Care Act is certainly imperfect, with high deductibles and premiums, so far, the data shows it’s making America a healthier nation.
The Affordable Care Act also bans annual dollar limits on health insurance. Before the bill was enacted, many health plans had a yearly limit for how much of your costs it would cover — exceed that, and you’re on your own. For anybody with a disease that requires ongoing treatment — like haemophilia or Crohn’s disease, for example — a limit would mean spending thousands each year on medical bills on top of insurance costs.
Miriam Laugesen, an associate professor and public voices fellow at Columbia University’s Mailman School of Public Health, explained to Gizmodo that because not all elements of Obamacare are necessarily unpopular, “each policy is going to be assessed according to political criteria”. Laugesen predicted that the parts of the bill that remain intact will be kept quiet, unless Republicans “rebrand them as a party policy”.
“It would be dangerous for them to undo everything,” Laugesen said. “It’s actually in their interest to maintain some of the policies, just not all of them, and a key will be figuring out which ones are responsive to their voters and supporters, and which ones can they afford to lose and even take credit for eliminating.”
What this means for Americans who rely on the Affordable Care Act for life-saving medication and treatments? They’re likely safe for at least another year, and after that, it’s the wild West. Chances are a full repeal of Obamacare is not going to happen, but that doesn’t mean Trump and his cronies can’t mutilate it beyond recognition.