What Is the Future of Obamacare?

Depression and Bipolar Support Alliance

With Republicans moving into the White House and controlling both houses of Congress, what can the American people expect to happen to “Obamacare” and what impact will that have for those of us living with a mood disorder and our families? If Obamacare collapses, will we have access to mental health care?

Many people are unaware of the connection between mental health parity and Obamacare. Mental health parity became law in 2008, making it illegal for insurance plans to provide different levels of coverage for mental health care as compared to medical/surgical benefits. However, it was the passage of the Affordable Care Act (ACA); often referred to as “Obamacare” that required all health insurance plans governed by this law to offer mental health coverage in the first place. Until Obamacare, insurance plans could side-step parity by simply not offering mental health coverage. As a new administration gets ready to take charge, many people are asking if they will still have affordable access to insurance plans that provide both physical and mental health coverage.

In order to fully understand the future of Obamacare, it is important to review how the federal government operates. Presidents do not have the authority to repeal existing laws. The Executive branch of the government does, however, play a large role in implementing laws passed by Congress. After his inauguration, the Trump administration can pursue policies that could destabilize the economic framework of Obamacare and undermine the viability of the health insurance marketplace. In a November 9, 2016, Health Affairs Blog post, Timothy Jost outlines some actions the Trump administration could take, and these are summarized below:

  • Eliminate regulatory enforcement. If no government agency is enforcing key components of the law or making sure that staffing is in place to administer the law, destabilization will take place through neglect.
  • Create lack of confidence. Many insurers have already left the exchanges. If the administration demonstrates a lack of commitment to the current program, many more insurers faced with uncertainty could decide to pull out as well. The net result: many states could be left without companies willing to offer insurance plans.
  • Revise Medicaid waivers. Current federal law allows states to request waivers that provide some latitude in how they administer Medicaid in their state. The Trump administration has the authority to increase waivers to states, allowing them to change funding agreements, program eligibility requirements, benefits, or to add greater cost-sharing requirements. These policies run the risk of states not having enough funding and dropping people from the program.

It takes both chambers to pass a law
Legislation becomes law when both the House and the Senate pass a negotiated bill. Once that happens, the bill is sent to the president who signs it into law. Although the Republicans in both the House and the Senate have a voting majority, it’s not a foregone conclusion that all bills will pass the Senate. Without having 60 votes, the Republicans in the Senate will not be able to overcome a Democrat filibuster. The net effect is that a piece of legislation can be stalled and not brought to a final vote in the Senate.

While a Senate filibuster can be used to stall repeal of policies within Obamacare, there are other ways Republicans in the Senate can repeal key provisions of the law. Use of a process known as reconciliation only requires 51 votes in the Senate. Reconciliation is a procedural tool to fast-track certain pieces of legislation through the Senate that have a budget impact—that positively or negatively impact spending. Certain parts of Obamacare that can be repealed through reconciliation include:

  • expansion of Medicaid
  • subsidies to purchase insurance
  • tax credits
  • penalties for not having insurance.

Similar to the Trump administration’s strategy to destabilize the very foundation of Obamacare, these measures would make the program unsustainable because insurance companies would leave the market and not enough people would be able to afford coverage. It also would result in millions of individuals potentially losing their coverage from Medicaid.

Congress does respond to voter preference
A recent Health Tracking Poll from the Kaiser Family Foundation shows that Americans are fairly evenly split in their opinion about Obamacare. An equal number, 45%, rated the program “favorable” or “unfavorable.” Given that Members of the House of Representatives are constantly in re-election mode (their terms are only two years), now is the time to mobilize. Call your Representative. Tell him/her that you support policies that allow you to retain hard-won rights that

  • eliminate economic penalties for pre-existing conditions
  • require insurance plans to provide mental health coverage
  • allow young adults up to age 26 to keep their parents’ coverage
  • make insurance premiums affordable.

Another way to make your voice heard is to call Speaker of the House of Representatives, Paul Ryan. In late November, he opened a phone line to conduct a poll. The survey can be accessed by calling either (202) 225-3031 or (202) 225-0600. In each case, there is a period of silence (up to 2 ½ minutes) before callers are asked to press “2” if they want to “express their opinion on President Obama’s healthcare law.” Once the recorded message is audible, you will need to press “2” to access the poll. Then press “1” to indicate your support of Obamacare. (These lines were opened in late-November, but may no longer be accessible.)

Most respected authorities estimate that 22 million Americans stand to lose insurance coverage if Obamacare is repealed and not replaced. That’s a lot of voters Congress will have to answer to in 23 months and a lot of hardship – physical, mental, and financial – that millions of people will experience in the meantime.

Your Turn

  • What would your situation be like if you lost your current insurance? How would you get care?
  • What changes do you think would improve health care coverage in the US?

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