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ObamaCare Is Saved. For Now.

So what does that mean? Are you secure and insured? Or are you still at-risk to lose coverage?

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By Barbara Alvarez

With Cheryl D. Munson

On Friday, March 24, President Trump decided to pull the Republican healthcare plan, nicknamed TrumpCare from a vote by the U.S. House of Representatives.  House Speaker Paul Ryan and President Trump both knew they didn’t have the votes they needed.

While many Obamacare insured breathed a sigh of relief, the truth is that this is not the end. Republicans still want to get rid of Obamacare, formally named the Affordable Care Act (ACA). Republicans fell short of getting ACA repealed and their replacement plan was not accepted. Even members in their own political party were against it.

This leaves the newly insured, fence-sitters, those on Medicaid, senior citizens and people who are self-employed to worry about what’s next.

The Republicans Can Still Make Changes to ObamaCare

Don’t think it’s over. Elizabeth Carpenter, senior vice president of Avalere Health, a DC-based healthcare consulting firm, specializing in strategy, policy, and data analysis for life sciences, health plans and providers, says that the Trump administration can do several things that won’t need the approval of Congress to put into effect. As a result, American consumers can still be faced with reduced coverage and sharply higher insurance premiums, almost without warning.

Even worse, Health and Human Services Secretary Tom Price has signaled his desire to remove many of the benefits for consumers covered under ObamaCare. Look for the Trump Administration to make cuts and eliminations to some of the essential health benefits that are mandatory under the current ACA/ObamaCare legislation.

What Republicans Have Already Done and Are Continuing to Do

When the ACA was signed into law by President Obama, 19 states opted not to expand Medicaid. Now, if the current Congress decides to tinker with Medicaid, even more people could lose coverage.

Even though the prospect of TrumpCare has died, Republicans in Congress have already taken quiet steps to make the ACA less effective. By doing so, they anticipate that cumulative damage will weaken the law to the point that it will collapse.

Allowing the ACA to Collapse

Republicans hold control of the U.S. House and Senate. As a result, this means it will be easy for them to allow the ACA to collapse, simply by exercising “benign neglect,” or just failing to ensure that all provisions of the law are equally enacted.

Trump has already stated that he intends to allow the ACA to fall under its own weight, and then lay the blame on the Democrats. Even before the Republican GOP version of the bill was written and discussed in committee, the White House put forth several changes intended to weaken the existing ObamaCare law. These changes include weakening the mandate that people obtain health coverage, and halting advertising to encourage people to sign up for an ObamaCare insurance plan.

To Insure – Or Not to Insure. That’s Still the Question.

People who currently have no coverage, as well as those who do have coverage, are understandably worried. “Do I get insurance or just allow my policy to lapse?”

This uncertainty, coupled with the negativity expressed by members of Congress is causing some people to lose confidence in the ACA, including health care consumers.

Additionally, and importantly, insurance providers who are participating in providing health insurance plans via exchanges are also wondering if they should pull out.

Andy Slavitt, Acting Commissioner of the Centers for Medicare and Medicaid, worries that the threats that Trump has made may become a sort of “self-fulfilling prophecy.”

States Uncovered. And County Corridors.

Many major insurance providers have already pulled out of the plan. Aetna dropped down from its initial 15 states to only offering coverage in four states. UnitedHealthcare, the largest provider in the nation will operate only in a “handful” of health insurance exchanges in 2017.  A total of 13 other major health insurance providers have opted to exit the ACA exchanges.

In many states, Blue Cross Blue Shield will be the only available provider. However, “the Blues” have requested to increase the cost of individual policies by 18.8% on average. While most of these increases won't be felt by consumers because they receive tax credits, that isn't the case for everyone. And Blue Cross Blue Shield has, like many, suggested that they may drop of the exchange.

"The issues with Blue Cross Blue Shield become even larger now that they may be the only option people can get through the exchange," said Fred Joyner, president of Carolina Benefit Administrators Inc., based in South Carolina.

The Risk Corridor Program. A Dirty Trick to Sabotage ObamaCare.

Several years ago, Republicans quietly sabotaged a little-known provision of the ACA. This section of the law is known as the “risk corridor program,” and it enables insurance companies to deal with the influx of sicker patients (those with pre-existing conditions). These companies would experience shortfalls because of the poorer pool quality of high-cost patients, even as younger, healthier adults signed up for ObamaCare. Under the “Risk Corridor Program” health insurance companies received payouts to cover their losses, enabling them to remain in the exchanges.

In 2014, Republicans forced several concessions to the ACA by threatening to shut down the government. The concessions were made. One of them weakened the ability of the government to fund shortfalls to individual insurance companies in the so-called Risk Corridor Program. This concession forced the government to characterize federal support for the risk corridor program as an insurance company bailout. The trick is that the payouts that these companies relied on would not be paid until other insurance companies paid enough into the risk program to “justify” a payout. As a result, this provided an excuse for companies to exit from the ObamaCare program. 

Executive Action and its Effects

On his first day in office, Trump signed an Executive Order directing applicable government agencies to “change, waive or delay” provisions of the ACA that are considered burdensome to several entities (insurance companies, doctors, drug companies, individual states and even patients). The order he signed weakened the power of the individual mandate to have health insurance coverage that is so fundamental and critical to the premium pricing and success of ACA.

Essential Health Benefits’ Future

We’ve been hearing a lot lately about “essential health benefits.” These are the 10 benefits required to be covered in every insurance plan sold in the exchanges. These may now be weakened by the Trump Administration and the GOP.

These 10 benefits include:

  • Outpatient care
  • ER visits
  • Inpatient hospital care
  • Pre- and post-natal care
  • Mental health care and substance use disorder services
  • Prescription medications
  • Medical devices, occupational, physical, speech/language therapies as well as psychiatric rehabilitation
  • Lab tests
  • Preventive services
  • Pediatric services, including vision and dental care

Subsidized Premiums Are At-Risk

Consumers who rely on subsidies to help them afford the cost of their insurance may soon see those removed. A lawsuit brought by the House of Representatives plans to end the subsidies that help low income Americans afford monthly premiums and out-of-pocket costs.

This will also have a negative effect on individuals and families that rely on Medicaid. The federal government may soon require states to develop stricter plans for future Medicaid recipients in order to expand coverage. One of these changes may be work requirements for Medicaid recipients.

So What Are We to Do. Going Forward.

It is important all stay informed about the status of ObamaCare. Be sure to read and share articles like this one. And sign up for online news alerts. Visit the websites of your city, county and state elected officials. And speak up. Tell them about your concerns and why affordable health care and insurance is important to you.

Speaker of the House, Paul Ryan, R-Wisconsin, and the closely named American Health Care Act that he and Trump pulled from voting.