FAQ: Affordable Care Act (ACA)
- Yes, the Affordable Care Act as we know it will be repealed whether it is completely repealed and replaced, or certain components of the act are repealed while others stay intact. The problem GOP leaders are now facing is how to go about repealing ACA; whether to repeal and replace, or to repeal the mandate and replace with something called a “continuous coverage incentive” or to repeal other components while keep certain aspects of the act written into law
- On January 3, 2017, Congress voted to begin the process of repeal through budget reconciliation (more below) and a few weeks later, President Donald Trump issued an executive order giving U.S. federal agencies under the executive branch license to reduce the economic burden of the ACA. While the order does not dismantle the law, it directs the Administration to stop enforcing certain aspects of the law. Think about it like getting rid of the health care police.
- Republican Members of Congress actively campaigned this past election cycle on the promise that they will repeal the ACA immediately, but there is no consensus from the election cycle about what comes next regarding the ACA.
- So to answer the question: Will ACA be repealed? Yes.
- And the answer to the question: Will it be replaced and if so, with what? Nobody knows.
- Payors could drop coverage due to a pre-existing condition, such as cancer diagnosis or remission status
- Children may not be able to have healthcare coverage through their parents’ coverage after turning 18 years of age
- The ban on lifetime caps on benefits could be lifted
- Subsidized cancer testing is in jeopardy
- Pre-cancer screenings would be in jeopardy for women over the age of 26 without health insurance because they would not be able to be on their parents’ coverage
- Adolescents and young adults with cancer with any lapse of coverage over a prior 18-month period could be charged upwards of 50% more on their premiums if the individual mandate is repealed.
- One reason why premiums are rising under the ACA is because more people than expected are choosing to pay penalties rather than buy health insurance. If Republicans strip the ACA of the requirement that individuals must have insurance, it is predicted that even fewer healthy people will buy coverage and premiums will rise even higher.
- A recent report by the Congressional Budget Office suggests that if the ACA is repealed, 32 million people would lose health care coverage and the price of insurance would double over 10 years.
- Republicans are proposing cutting back on required benefits and replacing the system with tax-preferred health savings accounts. This would likely reduce out of pocket costs for healthy individuals, but increase out of pocket costs for individuals who use the health services more frequently than the healthy individuals.
- Everything is on the table.
- Repeal Only: Some folks are still talking about this but the Urban Institute estimates over 29 million Americans, among immediate repeal, (read: constituents) will lose coverage if ACA is repealed without a replacement and have an impact on hospital economics. There would be a cumulative loss of 3 million jobs in the healthcare sector and other areas of the industries as a result of a repeal of certain provisions. Not really sound policy or politics.
- Repeal & Replace: This could be be a blend of current Republican plans which include everything from tax credits to lower premiums and encourage the use of health savings accounts to possibly rolling back the Medicaid expansion.
- Repeal & Delay: This would involve voting to repeal ACA and then delaying the replacement over a to be determined period of time.
- Gridlock. There’s also a very good chance that nothing happens in 2017 especially if the Republicans can’t get on the same page about what should be repealed, replaced, fixed, or delayed.
- No matter the politics, the Affordable Care Act is law and there are a number of protections and benefits associated with the law that the majority of Americans do not want to see go away such as wellness benefits and preventing payors from dropping coverage due to a pre-existing condition.
- Then there’s the vote count. The House and the Senate both need to get whatever repeal/replace/delay/etc. plan to pass both chambers which isn’t easy; let’s look at last congress:
- Congressional legislative success rate January 2009 (President Obama Administration)-present (President Donald Trump) = 2.6%, so the gridlock option is a real possibility.
- 11,865 pieces of legislation were introduced and only 696 of them got a vote in the House or Senate;.
- Of the 696 pieces of legislation voted on, 22 failed and 9 were vetoed by the President with zero congressional overrides.
- Don’t get it done in two years? Come back next time… and start from the beginning!
- And of course, there’s public opinion to think about. More Americans favor the ACA than oppose it for first time since 2012: 45% favor it.
- We love talking about budget reconciliation. It’s one of those wonky things only us policy nerds ever get to discuss at Thanksgiving since no one ever talks to us about politics.
- This process was actually used in 2010 to pass the Affordable Care Act. Basically, budget reconciliation is a way to get around the Senate filibuster rule which requires 60 votes to end debate (which is a supermajority of Senate).
- While this process seems fast, it has one very important rule: budget reconciliation can only impact federal funding. This means items such as the individual mandate and subsidies for insurers on the public exchange can be eliminated, but not benefits.
- Correct, it can only impact laws and regulations that have or need federal funding.
- Many of the protections that help the AYA community such as allowing children to stay on their parent’s insurance until the age of 26 are not federally funded and cannot technically be “repealed” through this process.
- See above re: why everyone can’t get on the same page.
- Taking away the individual mandate that requires everyone to have health insurance, but keeping the protections and regulations in place could crash the health care markets. The individual mandate helps get well people into the system before they are sick. Without it, some argue that Americans will wait until they are sick to get coverage which could be financial devastating to some insurance companies.
- Bottom line, this is complicated for experts and it is going to take even Congressional leaders some time to figure out how to find a legislative solution for the decided path.
- Incorrect. There is still reason to be alarmed for the AYA Community.
- Donald Trump signed an executive order directing federal agencies to “eliminate the financial burden of ACA” which is like saying, “We have these laws in place, but we aren’t going to pay the police to enforce them.”
- Some believe this language gives the Trump Administration a wide range of latitude to make significant decisions about ACA outside of the legislative process.
- The Department of Health and Human Services Secretary Tom Price said he plans to wait for Congress to pass a bill before doing anything with ACA, but as noted above, gridlock is an option and the question is what will President Trump and Secretary Price do if Congress cannot come to an agreement.
- Tom Price is the Secretary of Health and Human Services in charge of all U.S. health care policy implementation from ACA to FDA.
- He is an orthopedic surgeon by trade who served in the United States Congress as a Representative for the Georgia 6th Congressional District from 2005 to 2017 (his appointment as HHS Secretary).
- During his time in the United States Congress he served on the House Budget Committee (federal spending), and Ways and Means Committee (taxes).
- While serving in the House of Representatives, Secretary Price introduced legislation to delay a regulation that would hurt a medical manufacturers device profits after purchasing stock in the company, and also introduced legislation that pushed for the healthcare system to permit tax-preferred accounts and create loopholes for healthcare providers.
- During his confirmation hearing he stressed that a “continuous coverage incentive” should replace the “individual mandate.”
- Individual Mandate = Requires individuals to be covered by insurance through their employment or the marketplace. Failure to enroll imposes a $695.00 penalty per adult, $347.50 per child under the age of 18 and a maximum family penalty of $2,085.
- Continuous Coverage Incentive = Gives the opportunity to individuals to purchase health care coverage during an enrollment period, but the health of an applicant is taken into consideration when the healthcare provider determines the cost. Failure to enroll in coverage during the dedicated time period poses potential higher costs when attempting to re-enter the market; insurers can charge higher premiums, withhold coverage on certain health conditions or deny coverage altogether.
- Let’s say you are in active cancer treatment and you lose your job and cannot afford COBRA so you decided to forgo health coverage and work directly with the hospitals on billing. Six months later you are done with treatment and want to get basic health care on the open market. Under the “continuous coverage incentive” model you can access health care (i.e. you cannot be denied coverage) but the insurance company can charge you more since you recently went through cancer treatment (i.e. you have access but cannot afford coverage).
- Continuous coverage is not the best policy for adolescents and young adults impacted by cancer and may have even more devastating effects compared to pediatric or older adult patients. Even now, one in three AYAs will lose coverage at some point after diagnosis due to a life transition such as losing their job or aging off their parents’ insurance.
- You can call your federal elected officials and speak up for adolescents and young adults impacted by cancer.
- Call the Critical Mass Action alert line at 1-855-636-9777 to get connected now.
- We love questions! They actually really help us work our our FAQs and if there is something you think we’ve missed we want to add it in right away.
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Access to insurance is a critical barrier to adolescents & young adults surviving and thriving after cancer. #ayacsm #ayaacaClick To Tweet
Cancer isn’t just a preexisting condition. #AYAcancer survivors diagnosed between 15 & 39 need years of follow up care. #ayacsm #ayaacaClick To Tweet
FACT: 1/4 cancer patients diagnosed between 15 & 39 face time w/o health coverage after diagnosis. #ayacsm #ayacancer #ayaacaClick To Tweet
I was diagnosed with cancer at xx. My care cost xx. Insurance covered xxx. Access to coverage matters. #ayacsm #ayacancer #ayaaca Click To Tweet
Diagnosed with cancer between 15-39 and use Obamacare? Tell @heycriticalmass your story #ayacsm #ayacancer #ayaacaClick To Tweet
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