Our findings for the 2017 plans show that, as was the case in 2016, a total of 25 states have opted out of covering elective abortion on the Obamacare exchange. Elective abortion refers to abortion on demand and for any reason.The 25 remaining states (and the District of Columbia) permit elective abortion coverage in Obamacare plans.
Here’s how Republicans plan to repeal Obamacare within weeks of Trump taking office | Washington ExaminerDecember 16, 2016
In the weeks following the presidential election, there’s been some debate about whether Republicans would actually go through with repealing Obamacare as opposed to getting cold feet. But after a number of conversations with senior GOP leadership aides in both chambers of Congress, this is the message I’ve received: Republicans are moving full-speed ahead on Obamacare, and could have a bill repealing much of the law on President Trump’s desk within weeks of him being sworn into office.
What Are the Implications of Repealing the Affordable Care Act for Medicare Spending and Beneficiaries? | The Henry J. Kaiser Family FoundationDecember 14, 2016
This brief explores the implications for Medicare and beneficiaries of repealing Medicare provisions in the ACA. The Congressional Budget Office (CBO) has estimated that full repeal of the ACA would increase Medicare spending by $802 billion from 2016 to 2025.1 Full repeal would increase spending primarily by restoring higher payments to health care providers and Medicare Advantage plans. The increase in Medicare spending would likely lead to higher Medicare premiums, deductibles, and cost sharing for beneficiaries, and accelerate the insolvency of the Medicare Part A trust fund. Policymakers will confront decisions about the Medicare provisions in the ACA in their efforts to repeal and replace the law.
Publicly-funded reinsurance or well-funded high-risk pools would more directly subsidize the costs of the sickest people, whereas the ACA effectively requires healthy people to subsidize the sick (with protection for lower-income people through subsidies), which has proven difficult in the relatively small individual market, particularly in certain localities. Reinsurance or high-risk pools could make it possible to cover sicker individuals while keeping premiums sufficiently low in the individual market to attract healthier people.
Atkins and her husband received a $708 monthly tax credit, which would cover most of their premium. But they would still need to contribute $244 each month — and face a $6,000 deductible.
Atkins said she had insurance before the Affordable Care Act that was significantly more affordable, with $5 copays and no deductible at all. She said she paid only $200 or $300 each month without a subsidy.
The deductible left Atkins exasperated. “I am totally afraid to be sick,” she says. “I don’t have [that money] to pay upfront if I go to the hospital tomorrow.”
In this brief, we compare future health care coverage and government health care spending under the ACA and under passage of a reconciliation bill similar to one vetoed in January 2016. The key effects of passage of the anticipated reconciliation bill are as follows:
- The number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people (103 percent).
- The share of nonelderly people without insurance would increase from 11 percent to 21 percent, a higher rate of uninsurance than before the ACA because of the disruption to the nongroup insurance market.
- Of the 29.8 million newly uninsured, 22.5 million people become uninsured as a result of eliminating the premium tax credits, the Medicaid expansion, and the individual mandate.
- The additional 7.3 million people become uninsured because of the near collapse of the nongroup insurance market.
- Eighty-two percent of the people becoming uninsured would be in working families, 38 percent would be ages 18 to 34, and 56 percent would be non-Hispanic whites.
- Eighty percent of adults becoming uninsured would not have college degrees.
- There would be 12.9 million fewer people with Medicaid or CHIP coverage in 2019.
- Approximately 9.3 million people who would have received tax credits for private nongroup health coverage in 2019 would no longer receive assistance.
- Federal government spending on health care for the nonelderly would be reduced by $109 billion in 2019 and by $1.3 trillion from 2019 to 2028 because the Medicaid expansion, premium tax credits, and cost-sharing assistance would be eliminated.State spending on Medicaid and CHIP would fall by $76 billion between 2019 and 2028.
- In addition, because of the larger number of uninsured, financial pressures on state and local governments and health care providers (hospitals, physicians, pharmaceutical manufacturers, etc.) would increase dramatically. This financial pressure would result from the newly uninsured seeking an additional $1.1 trillion in uncompensated care between 2019 and 2028.
- The 2016 reconciliation bill did not increase funding for uncompensated care beyond current levels. Unless different action is taken, the approach would place very large increases in demand for uncompensated care on state and local governments and providers. The increase in services sought by the uninsured is unlikely to be fully financed, leading to even greater financial burdens on the uninsured and higher levels of unmet need for health care services.
- If Congress partially repeals the ACA with a reconciliation bill like that vetoed in January 2016 and eliminates the individual and employer mandates immediately, in the midst of an already established plan year, significant market disruption would occur. Some people would stop paying premiums, and insurers would suffer substantial financial losses (about $3 billion); the number of uninsured would increase right away (by 4.3 million people); at least some insurers would leave the nongroup market midyear; and consumers would be harmed financially.
- Many, if not most, insurers are unlikely to participate in Marketplaces in 2018—even with tax credits and cost-sharing reductions still in place—if the individual mandate is not enforced starting in 2017. A precipitous drop in insurer participation is even more likely if the cost-sharing assistance is discontinued (as related to the House v. Burwell case) or if some additional financial support to the insurers to offset their increased risk is not provided.
This scenario does not just move the country back to the situation before the ACA. It moves the country to a situation with higher uninsurance rates than was the case before the ACA’s reforms. To replace the ACA after reconciliation with new policies designed to increase insurance coverage, the federal government would have to raise new taxes, substantially cut spending, or increase the deficit.
Laszewski’s Vox interview suggests that industry executives are blaming this death spiral on Trump’s plan to repeal and replace it. If so, it is a false narrative. Hillary Clinton’s election would not have forestalled Obamacare’s collapse. She would have used the crisis as a pretext for making government-run health plans available in the exchanges. Trump’s election offers an opportunity to move instead toward market-based solutions.