On Monday night, the Republican plan to repeal and replace Obamacare died when they couldn’t get enough votes. Not long after, an alternative plan of just repealing the ACA and replacing it later also died, for the same reason. This is good news. But danger still abounds for our health care system and for people like me.
Lacking clarity from Congress, the White House’s powers over the nation’s health policy loom large and murky. Although President Trump on Tuesday reiterated his intention to “let Obamacare fail,” he has not yet made two critical decisions.
Most immediately, the administration has the power to decide whether to halt the billions of dollars in payments to health plans that help their lower-income ACA customers afford deductibles and other coverage expenses. Those cost-sharing subsidies benefit 7 million Americans. The president could turn off the spigot by dropping an appeal of a federal lawsuit filed by the House of Representatives over the payments’ legality.
The other decision is whether to ease off enforcement of the ACA’s penalty for Americans who shirk the coverage mandate. Trump cannot end the mandate without a change in law, but the Internal Revenue Service recently said it would continue to process refunds even when taxpayers flout a requirement to file proof that they have health coverage. The administration could go further.
“We are still considering our options,” White House spokesman Ninio Fetalvo said.
The disarray in the Senate and the ambiguity in the administration “just continues the sort of volatile environment,” said one insurance industry official, speaking on the condition of anonymity because of the political sensitivities. “It’s adding uncertainty to what was already an uncertain climate.”
If the mandate is ended, officially or unofficially, the health care exchanges will either collapse entirely as insurers flee the markets, or the premiums will skyrocket because healthier people will opt out of them without fear of penalty. That would essentially convert the ACA exchanges into high-risk pools. Either of those options would be an absolute disaster, especially for people like me.
Because I’m self-employed and have a preexisting condition, the ACA is the only way I can get affordable health insurance. And as someone with multiple chronic conditions, my ongoing medical costs are massive and lack of health insurance would be indistinguishable from a death sentence. The Republicans could not possibly care any less, of course, especially Trump. All he wants is a bill to sign, any bill, no matter how cruel or how horrible the consequences.