Seven years ago next month was the passage of the Affordable Care Act. With President Trump and the Republicans in Congress vowing to repeal President Obama’s trademark legislation, there is some doubt as to whether Obamacare will see its seventh birthday. With signups for the program falling and insurance companies leaving its marketplaces, Obamacare seems to be dying a slow death even without a formal repeal.
According to CNN, federal Obamacare enrollments were down from last year by 400,000. Only 9.2 million people signed up at healthcare.gov which handles Obamacare registrations for 39 states. Last year, 9.6 million people signed up at the site.
Eleven states and the District of Columbia run their own exchanges so figures for the entire country are not yet available. A total of 13.8 million people were expected to sign up nationally. CNN reported last month that 11.5 million people had signed up as of Dec. 24, an increase over the previous year at that point.
Backers of the health law blamed a decision by the Trump Administration to end advertising for the Obamacare enrollment for the uninspiring finish. The Trump Administration placed the blame on a 25 percent premium increase and a 28 percent decrease in the number of participating insurance companies.
Last August, Aetna announced that it was withdrawing from the Obamacare exchanges while Humana and United Healthcare sharply reduced their presence. A Washington Times report found that almost a third of counties would have only one Obamacare insurance company available. The lack of options for many consumers would mean restrictions on networks and choice of doctors. For example, Molina Healthcare excludes Cedars-Sinai Hospital, a prestigious Los Angeles facility, from its networks to cut costs. Only about a quarter of Obamacare insurers were profitable last year.
“Obamacare has failed the American people, with one broken promise after another,” Matt Lloyd, spokesman for the Department of Health and Human Services, told CNN. “We look forward to providing relief to those who are being harmed by the status quo and pursuing patient-centered solutions that will work for the American people.”
Obamacare has not lived up to its promises. President Obama touted the Affordable Care Act as “universal coverage for all Americans” and said that it would reduce health insurance costs for American families. The law failed on both counts. While the US uninsured rate did decline under Obamacare, it remains at almost 11 percent according to Gallup survey. CNN noted that the average health insurance premium has increased by about 50 percent over the past eight years. Additionally, higher deductibles on current plans mean that consumers pay even more out of pocket.
With the uncertainty of a possible repeal or reform, many large insurers are weighing their options for next year. Politico reports that the Trump Administration is considering proposals to limit enrollment outside the open enrollment period and increase costs for older Americans. A major factor in rising premiums and falling profits has been adverse selection as Obamacare enrollees have turned out to be both older and sicker than predicted.
“We saw very little of the young and healthy,” Sherri Huff, a consultant and former health care coop official, told Modern Healthcare.
Ironically, recent polling has shown an increase in Obamacare’s popularity. A CNN poll from January showed a small lead (49-47 percent) for those who favor the law for the first time since its passage. Even this poll shows that 55 percent would support repeal if a replacement can be enacted simultaneously. Polls by Rasmussen and Fox News confirm that Americans want a replacement for Obamacare before a repeal. The polls agree that majorities don’t want the Affordable Care Act in its current form and they don’t want to go back to the 2009 status quo.
In spite of Obamacare’s flaws, Republicans face two problems with its repeal. First, is the estimated 30 million people who could lose coverage if Obamacare is repealed. Some of these people could find insurance elsewhere in a restructured market, but others are uninsurable and like their Obamacare plans. Public opinion would not allow Republicans to simply eliminate coverage for millions.
President Trump has already promised an expansion of health insurance coverage. “We’re going to have insurance for everybody,” Trump said last month. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
Finally, there is the structural problem of 48 Senate Democrats who can filibuster a replacement bill. While Obamacare can be repealed via a majority vote in a budget reconciliation, the same way it was passed, but if it isn’t simultaneously replaced Democrats will have an opportunity to block later legislation that requires 60 votes for cloture. Currently, Republicans have not agreed on a replacement plan.
This double bind means that Republicans run the risk of alienating a large part of the country no matter what they do. Either they anger the conservative base by not acting immediately on a repeal or they act rashly and possibly cause even more problems for the Americans and their health care.