With Trump as president & Republican Congress, 22mn people could lose health insurance

Both Trump and the Republicans en masse have repeatedly slammed the current healthcare system, Barack Obama’s signature Obamacare (Patient Protection and Affordable Care Act). For six years now they have been making calls for the act to be repealed, but so far only managed to pass several bills amending it.

The criticism skyrocketed two weeks ago when the Obama administration announced that Obamacare premiums will be further increased next year, while the choice of insurers will be cut by half.

Now it could all change, and soon, experts say.

“They have a death blow to the Obamacare health coverage expansion,” John McDonough, a Harvard University professor who worked in the Senate on the passage of the Affordable Care Act told Vox news outlet. 

Under Obamacare, the government requires most people to have health insurance, provides subsidies of billions of dollars in premiums, and imposes fines for those uninsured. It was passed in 2010 aiming to lower the cost of healthcare and make it more affordable for lower-income Americans. But the faults that surfaced in the system once it came into law have sparked a lot of criticism, with Republicans having dubbed it “dishonest.”

“Any honest agenda for improving healthcare must start with repeal of the dishonestly named Affordable Care Act of 2010: Obamacare. It weighs like the dead hand of the past upon American medicine. It imposed a Euro-style bureaucracy to manage its unworkable, budget-busting, conflicting provisions. It has driven up prices for all consumers […] It drove up drug prices […] It must be removed and replaced with an approach based on genuine competition, patient choice, excellent care, wellness, and timely access to treatment,” the GOP platform reads, promising further to repeal the system if a Republican enters the Oval Office.

“To that end, a Republican president, on the first day in office, will use legitimate waiver authority under the law to halt its advance and then, with the unanimous support of Congressional Republicans, will sign its repeal.”

Trump himself has promised repeatedly that repealing Obamacare, which he called a “complete disaster,” would be his first act in office.

“If we don't repeal and replace Obamacare, we will destroy American health care forever,” Trump said at a rally in Pennsylvania last week.

Outlining plans for his first 100 days in the White House a week before the election, he also swore to replace it with a health savings accounts program.

“On Day One of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare,” Trump’s website states.

However, the Congressional Budget Office estimates that if this happens, 22 million people would lose their health insurance, mostly the people who had attained coverage for the first time as the law cancelled pre-existing conditions and expanded Medicaid to cover more low-income Americans. Especially as Trump himself does not have a healthcare platform to replace Obamacare with.

“Practically, you can’t turn everything off immediately,” Chris Condeluci, tax and benefits counselor for the Senate Finance Committee's Republicans during the Affordable Care Act debate, told Vox. “The GOP doesn’t want to get beat up over kicking 20 million people off of insurance.”

To avoid this “beating,” in 2015 the Republicans drafted bill HR 3762 that would make the transition from Obamacare to another system smoother. The bill would repeal Obamacare’s tax credits for low- and middle-income Americans to purchase insurance by the end of 2017 and end the system’s Medicaid expansion, which will automatically create a two-year transition period, when Americans would still be able to enjoy health insurance coverage and authorities would be able to consider options to replace Obamacare. The problem, experts say, is that there is no alternative to replace it quickly.

“I don’t think the two [repeal and replace] would come in tandem,” Condeluci stated. “Replace needs to be litigated to a greater degree than it has before.”

The Republicans did publish a document outlining their Obamacare replacement plan this summer, which envisions a number of health policy proposals. But it is not in legislative form.

“I would envision Trump looking to Congress to drive the replace process, just as the Obama administration did with the Affordable Care Act,” Condeluci said.

“I am going to take care of everybody,” Trump said in an interview to CBS’ 60 Minutes last year. “I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

With no replacement plan to speak of, however, critics doubt whether Trump’s administration will stick to its promise.