Democrats are trying to save Obamacare as Trump chips away at the landmark health care bill

Democrats are trying to save Obamacare as Trump chips away at the landmark health care bill


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President Donald Trump escalated his attacks on Obamacare, a day after his administration asked a federal court to strike down the entire law. Speaking in the Oval Office, he said Republicans “will be the party of great health care.” (March 27)
AP

WASHINGTON – The ongoing thrust and parry between Democrats and the Trump administration over Obamacare may leave the average person wondering what health care coverage created by the 2010 landmark law is still available and what’s changed.

House Democrats will continue their vigorous defense of the Affordable Care Act Thursday when they bring to the floor measures to roll back some of President Donald Trump’s alterations to the law. Democrats’ package includes provisions that would block Trump’s expansion of short-term plans that don’t meet all the ACA’s requirements and would restore outreach funding that helps people enroll in Obamacare plans.

Some of Trump’s changes are also being challenged in court.

And that’s where Republicans are still trying to overturn the entire law, which they weren’t able to undo when they controlled both the House and Senate.

For now, people who aren’t covered through a government or workplace plan can still get insurance through Healthcare.gov. However, there’s less support from the government to help them enroll. And there are options for other kinds of plans that are cheaper but less comprehensive.

Here’s what consumers need to know about where the law stands.

What’s changed?

Republicans got rid of one of the most unpopular parts of the law – the individual mandate – by using their 2017 package of tax cuts to eliminate the ACA’s tax penalty for people who don’t have insurance.

On its own, the administration stopped reimbursing insurers for the discounts they’re required to give lower-income customers to reduce out-of-pocket expenses. (Insurers, however, are still required to give customers the discounts.)

The administration cut in half the amount of time people have to enroll in plans. And the Department of Health and Human Services dramatically reduced funding used to make people aware of the enrollment period and to offer in-person assistance to enrollees.

The department has also told states that they can create new types of insurance plans that don’t comply with all the ACA’s rules – such as what benefits must be covered and the law’s ban on tying premiums to health status. But no state has asked to do that.

The administration has expanded the availability of short-term plans, which cost less because they limit – or exclude – some types of coverage. (For example, short-term policies typically don’t cover maternity care, prescription drugs, mental health care, and preventive care.)

Republicans argue consumers need more options because the Obamacare plans are too expensive. Democrats say the alternative plans mislead people into thinking they will get the care they need if they get sick –  while also driving up the premiums of more comprehensive Obamacare plans by siphoning away healthier customers.

The House voted primarily along party lines this month to block the administration from letting states offer looser plans. And the package of bills being considered Thursday would roll back the expansion of short-term plans, as well as provide new funding to help people enroll in Obamacare plans.

Those bills are expected to die in the GOP-controlled Senate. But the expansion of short-term plans is also being challenged in court.

What’s in limbo?

Some of Trump’s changes have already been blocked – at least temporarily – by legal challenges.

A federal judge in January imposed an injunction on a dramatic expansion of employers’ ability to exclude contraceptive coverage in insurance plans for religious reasons.

And in March, a federal judge said Trump’s plan making it easier for small employers to band together to buy insurance was “clearly an end-run around the ACA.” But some states that supported the change may not enforce the judge’s ruling on plans sold in their jurisdictions, Kaiser Health News has reported.

In July, the Fifth Circuit Court of Appeals will hear oral arguments in the attempt by GOP attorneys general to have the entire law struck down. The Justice Department has told the court it agrees with the challengers that the law is unconstitutional.

If the law is overturned, nearly all Americans would be affected in some way, according to the nonpartisan Kaiser Family Foundation.

What hasn’t changed?

For now, the basic structure of Obamacare remains. People who aren’t offered insurance through an employer or a government program can buy Healthcare.gov plans, with subsidized premiums for those earning up to 400% of poverty. People with incomes up to 250% of poverty are also eligible for reductions in deductibles and other out-of-pocket costs. (On average, a 40-year-old making $45,000 pays $227 a month for a subsidized low-cost plan, according to the Kaiser Family Foundation. If the same person earned $50,000, the plan would cost $340 a month without the subsidy.)

Enrollment, however, is down about 10% from its peak of 12.7 million in 2016.

Popular parts of the ACA are intact. Young adults up to age 26 can stay on their parents’ insurance plans. Preventive services, such as flu shots and mammograms, must be covered without co-pays or other cost sharing. Insurers can’t exclude sick customers or charge them more. Insurers also can’t put annual or lifetime dollar limits on most benefits. And they have to issue refunds if they end up needing less than a specified share of premiums collected to cover health care expenses.

The law’s expansion of Medicaid eligibility remains, although more than a dozen states have chosen not to go along.

What would Democrats do if they were in charge?

Besides trying to undo Trump’s changes – and prevent more – Democrats have introduced legislation to expand the ACA. That would include making premium subsidies for Obamacare plans more generous as well as available to higher-income families.

That proposal is separate from the Democrats’ intraparty debate on whether to expand coverage through government plans instead of using subsidized private insurance. While the strongest advocates for “Medicare for all” envision eliminating all or most private insurance, others want to give people the option of remaining in a private plan or buying into a government-run plan like Medicare or Medicaid.

How many people still lack insurance?

The number of Americans without health insurance increased again in 2018, the second consecutive year that figure has risen after several years of declines under Obamacare, a Centers for Disease Control and Prevention survey shows.

About 30.4 million Americans did not have health insurance in 2018, up from 29.3 million in 2017, according to the CDC’s National Health Interview Survey.  That means about 1.1 million more Americans lost insurance coverage last year. 

The CDC survey followed a Congressional Budget Office report last month that found a similar decline in health coverage after years of gains under the Affordable Care Act. 

Contributing: Ken Alltucker

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