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Everything you need to know about repealing the Affordable Care Act

A full breakdown of what's going on, possibilities for replacements, how these changes could affect you, and what you can do to voice your opinion.

Today, we’re tackling the looming repeal of the Affordable Health Care Act.

1. What’s happening on The Hill

Americans woke up Thursday morning to news of the first bill related to repeal Affordable Care Act. Word quickly spread across social media that Congress had voted to repeal the ACA. That is not strictly true, which matters because there is still a lot that can be done to defend parts of the ACA.

Republicans are not in agreement about what they want or how to get it done. Click To Tweet

The bill was passed as part of the Budget Reconciliation Process, which broadly speaking is a way for legislation to be passed much more easily than normal since it can’t be filibustered in the Senate. The legislation passed on Wednesday night is limited to issues regarding debt and spending, which will further complicate the wrangling committees will have to do between now and their self-imposed deadline of Jan 27. On that day, the two chambers of Congress will vote and can pass the repeal of the ACA with a simple majority – then the legislation goes to President-elect Trump for a signature.

There’s a lot of contention surrounding a possible repeal, even among Republicans. 

2. Republicans are not in agreement about what they want or how to get it done.

There are still questions about whether Republicans in Congress are really willing to go ahead with a complete repeal of the ACA. This would include the repeal of provisions which are very popular across political lines, such as allowing people to stay on their parents’ plans until they are 26 and making it illegal for insurance to deny coverage to people with pre-existing conditions.

The country could face a healthcare crisis come election year. Click To Tweet

The Republican governors of states that expanded Medicaid, such as Rick Snyder in Michigan and John Kasich in Ohio, have been trying to slow down the process for fear of the political repercussions.  There are also a handful of Republican senators who are concerned that the current timeline will not allow for a replacement plan to be enacted simultaneously as President-elect Trump had promised.

Even if the deadline for a vote is moved to early March, it does not leave much time to find a way to reconcile cutting the budget while lowering healthcare costs and continuing to provide healthcare for the millions of Americans who have been insured under the Affordable Care Act. If they cannot manage to do that, the country could face a healthcare crisis which along with its human costs will not look good for them come election year.

What can we look forward to in the upcoming weeks? 

3. The fate of the Affordable Care Act is in the hands of Republican legislators

At this point, the fate of the ACA is in the hands of Republican legislators, particularly in the Senate where a defection of more than two Republicans could put repeal in real jeopardy. Right now, seven senators could vote no and the list could grow.

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Republicans have put forth a number of alternative plans. Two high-profile options are Speaker Paul Ryan’s A Better Way and Orrin Hatch’s Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act.

A Better Way will probably have a major influence on whatever Republican replacement plan we actually end up with because it comes from the House Speaker’s Office, so let’s break that one down.

Breaking down Paul Ryan’s replacement plan: 

4. Possibilities for replacement –  “A Better Way” at a glance:

  • Completely repeals the ACA – so everything would be starting from scratch.
  • Pre-existing condition coverage would be mandatory for health insurers, but they would have the right to charge sick patients more if there is a lapse in their coverage. If someone with a pre-existing condition leaves their job, for example, and does not immediately transition their insurance, they can be charged more when they do seek insurance. If there is no lapse, there can be no price hike because of their condition. These Continuous Coverage Protections are found in a number of Republican plans and are meant to encourage people, notably healthy people, to maintain their insurance even when they don’t need it. This solves the problem of the individual mandate, which has received much ire from the GOP in the years since the ACA was enacted.
  • Health insurance will be more affordable for the young and healthy, and more expensive for the old and sick. While Obamacare limited the amount insurers could charge its oldest customers to three times what it’s youngest paid, A Better Way increases that to five times.
  • A Better Way caps the tax exclusion for employer-sponsored coverage. Right now, full-time employed people get massively discounted health insurance because the government doesn’t tax health benefits. This will make certain health insurance plans much more expensive.
  • Essential Benefits will be scrapped. This is a part of the ACA which made sure that insurance covered ten basic benefits such as maternity and pediatric care, as well as prescription drug and mental health care. Insurance companies will be able to cut whatever services they want, including expensive care which benefits the most sick.
  • Premiums could go down for many people, but they would have less coverage. 
  • Subsidies are given based on age, regardless of income. Basically even the most wealthy of seniors would have generous tax credits and even the poorest of young people would have significantly less help to pay for insurance.
  • Medicaid will be decreased to pre-ACA levels starting in 2019. Medicaid funding would be sent to the states which would use block grants to fund it. Federal funding of Medicaid would be decreased. States that have expanded Medicare would be free to keep it as is, but states would also have the right to scale it back.
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There are a couple other replacement plans that have been put forth by GOP lawmakers, most of which seem to be riffs on A Better Way.

Since we don’t know what the alternative looks like exactly, here’s what we think could happen. 

5. What this could mean for you.

Right now, it’s unclear exactly what a replacement plan will look like, but here are some safe bets as to how it could affect women:

1. Birth control coverage will go back to being hit or miss. Plenty of insurers and companies don’t like having to cover birth control and this will no longer be a guarantee.

2. Young women who make less money, especially those benefitting Obamacare subsidies will see the price of their insurance go up. That price hike will be even more if they allow their health insurance to lapse and have a pre-existing condition.

3. It’s not clear which other essential benefits which primarily help women would be dropped by insurers. Pediatric and maternity care would, of course, affect women disproportionately if coverage was significantly reduced by insurers.

Take action. 

6. So, what can you do?

The answer is mostly to wait and see, but there are a couple of actions which you can take to influence lawmakers.

1. Call your representatives now, particularly if they are Republicans. State your opposition to repeal and make it clear what parts of the ACA are important to you.

Following is a list of some vocal Republican Senators on the committees which are writing the repeal bill. Their constituents need to be calling them. It doesn’t hurt to call the Democratic members of these committees, but their votes are pretty much locked in. Here are the full lists of all the members of the Finance Committee and the HELP Committee. 

  • Orrin Hatch (R, Utah). Finance Committee chair.
  • Lamar Alexander (R, Tennessee) Health, Education, Labor, and Pensions (HELP) Committee chair.
  • Susan Collins (R, Maine)
  • Rand Paul (R, Kentucky)
  • Pat Toomey (R, Pennsylvania)
  • Dean Hiller (R, Nevada)

2. Share the realities of what repeal and replace will mean for vulnerable Americans. Lift up the voices of the people who will most be affected by this.

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Katherine Kaestner

Katherine Kaestner

Editorial Fellow Katherine Kaestner is a writer, photographer and marketer currently based in Germany. She is passionate about wine, farmer's markets, unapologetic feminism, and foreign policy. She is a nomad who's lived in 12 countries and cities around the world and doesn't really know where home is.

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