Trump’s plan to repeal Obamacare on shaky ground

President-elect Donald Trump consistently called for a repeal of the Affordable Care Act during his campaign, but his plan to replace it has remained a mystery.

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

His website said he plans to propose reforms to broaden health care access and make higher quality health care more affordable.

Jonathan Oberlander, a UNC professor in the Gillings School of Global Public Health, said there is little information about Trump’s plans for health care beyond a few traditional Republican positions.

“He never released a full-fledged health plan during the campaign,” Oberlander said. “So his health plan consisted of about a half a dozen bullet points and they were more slogans than policies.”

Cynthia Cox, associate director of the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation, said there has also been little discussion about how the 20 million people who have gained coverage through the ACA will continue to receive coverage. She said a replacement policy could take years.

“So what happens to the 20 million in the interim?” Cox asked.

Sylvia Burwell, secretary of Health and Human Services under the Obama Administration, said in a speech at the White House on Monday Americans do not want to see the act repealed.

“People still want and still need affordable, quality coverage for 2017, and HealthCare.gov still offers it,” she said. “The Affordable Care Act is now woven into the fabric of our nation.”

Oberlander said despite Trump’s ideas, it is unlikely Republicans will be able to completely repeal the ACA.

“Republicans don’t have the votes in the Senate to do it,” he said. “They don’t have a filibuster-proof majority, so they have to use something called reconciliation where you only need a simple majority and you can get rid of much of the law that way but not all of it.”

Oberlander said even though the ACA is not popular as a whole, there are parts of the law that people enjoy. He said examples of these include the prohibition against discrimination toward people with pre-existing conditions and the provision to allow children to remain on their parent’s plans until the year they turn 26.

During a 60 Minutes interview on Sunday, Trump said he wants to try and keep these popular provisions and he will replace the ACA immediately after it is repealed.

Cox said a plan to repeal parts of the Affordable Care Act while keeping others is especially complicated as many popular provisions are related to and depend on other, less-popular parts of the law.

She said if only unpopular sections, such as the individual mandate requiring everyone to be insured or pay a penalty, are cut out, the law cannot survive and insurance markets would collapse.

Oberlander said there are about 600,000 North Carolinians who get their health care through the ACA.

“That includes a lot of people who could not afford coverage before the Affordable Care Act, it includes lots of people who couldn’t get coverage because they had a pre-existing condition, and their coverage is at risk,” he said. “They may well lose coverage in incoming years if the law is repealed and if the replacement is not adequate.”

@cjfarris21

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