On the night of the election three weeks ago, Rochelle Bird stayed up late watching the returns with a friend.
Bird, a financial adviser from Overland Park, Kansas, recalled being in knots in the days leading up to the election.
“If it didn’t go the way of [Donald] Trump, the next four years and possibly eight were going to be hell on wheels to financially endure in this country,” Bird told The Daily Signal.
So when the Associated Press eventually announced real estate mogul Donald Trump as the winner, Bird let out a sigh of relief.
Public policy affects Bird, as it does many other Americans, and she says she hopes that policymakers will consider people like her while making decisions in Washington, D.C.
Bird doesn’t expect to like everything Trump does after he takes office Jan. 20, but there’s one issue in particular she’s watching: health care.
Bird is one of roughly 10 million Americans who doesn’t receive insurance from an employer—she’s self-employed—and also doesn’t qualify for a subsidy. So when insurers announced double-digit premium increases for 2017, she prepared to pay full price for coverage purchased in the individual market.
And that wasn’t it.
Coventry Health Care sent Bird a notice last month saying it would cancel her policy at the end of the year.
On the first day of open enrollment, the Overland Park resident selected a new plan through Blue Cross Blue Shield of Kansas City, one that is only $50 more than her old policy.
But though Bird’s premiums increased minimally compared to others across the country, her deductible is higher and she has less coverage than with her previous plan.
“I’m paying more for less,” she said.
According to the Obama administration, 20 million Americans gained health insurance coverage under Obamacare. While many of those 20 million may be worrying about the future of their health insurance in a Trump administration, Bird isn’t one of them.
And she’s not alone.
“For the percentage of people who have been helped, it’s significantly impacted people in a disproportionate way,” Bird said of Obamacare. “It’s irrational. If you want to say we want to be a country that makes sure everyone has an option for health care, OK. But we’ve proven this isn’t working.”
Repeal Before Replace
Republicans in Congress voted more than 60 times to repeal the Affordable Care Act, popularly known as Obamacare, and each bill failed to make it out of the Senate and go to the White House.
But following Trump’s victory Nov. 8, GOP lawmakers are fine-tuning their strategy to get a bill repealing the health care law to Trump’s desk in the White House—a bill he is likely to sign.
Trump said repeatedly on the campaign trail he would repeal Obamacare and is in favor of allowing insurers to sell policies across state lines, expanding access to health savings accounts, and creating block grants for Medicaid.
Earlier this month, leaders of the House and Senate budget committees endorsed a repeal plan that involves passing two budget resolutions—one for 2017 and one for 2018—that include instructions for reconciliation, a budget tool that allows legislation to pass the Senate with only 51 votes.
Congressional Republicans used reconciliation to repeal Obamacare in 2015, but President Barack Obama ultimately vetoed the bill earlier this year. Now, they’re looking to use that legislation as a model to roll back the health care law in 2017.
Republicans haven’t yet agreed on a replacement plan for Obamacare, but House Majority Leader Kevin McCarthy, R-Calif., told reporters Tuesday that replacement would come later.
“My personal belief, and nothing’s been decided yet,” McCarthy said, “but I would move through and repeal and then go to work on replacing.”
Republicans have said they want to ensure those with coverage through Obamacare have a smooth transition to the new system, and legislation dismantling the law likely would include a delayed enactment date, giving lawmakers time to craft and pass a new plan.
But some health policy experts believe any Obamacare replacement could take years to put into place.
“If we’ve learned anything, it’s that implementation isn’t automatic,” Timothy Jost, a law professor at Washington and Lee University School of Law, told The Daily Signal.
“The idea that we can repeal by Jan. 6—there are going to be millions grievously hurt by this, including people who have coverage through the Affordable Care Act and don’t have the money and can’t get the money to cover cost-sharing or insurance on their own,” Jost said.
Indeed, some Americans are worried about the future of their coverage come 2018.
In an interview with CNN earlier this month, Ron Pollack, executive director of the pro-Obamacare group Families USA, said there could be significant backlash from consumers if health insurance under Obamacare is taken away.
“There are a lot of things we don’t know yet [about a replacement plan], but we do know there are tens upon tens of millions of people who depend upon the Affordable Care Act, who depend on Medicaid, and, of course, they are terribly worried that the coverage they have would be taken away,” he said.
Still, health policy experts advocating Obamacare’s repeal are encouraging policymakers to set a timeline to ensure reforms are in place by 2019.
In a paper released last week, Nina Owcharenko and Ed Haislmaier of The Heritage Foundation said Congress should not allow provisions of the Affordable Care Act, such as the subsidies, to expire before new measures take effect:
Timing and sequencing of these efforts are complex, and proper execution is critical. Congress, the new administration, and the states should work together to ensure a smooth transition for the repeal of Obamacare and to create a path toward a more patient-centered, market-based approach to reforming the health care system.
Like Bird, Warren Jones, a veterinarian in Missouri, is also optimistic about Obamacare’s repeal and what will replace the law.
“It’s a good thing overall, and I think everybody is open to the optimism of it,” Jones told The Daily Signal. “The media has been portraying it in such a way that Trump was going to take all the insurance away from the people that were insured on Obamacare.”
“He’s not talking about ripping everyone’s insurance away,” Jones said. “He’s talking about replacing it with something better, and that doesn’t mean you take everyone’s insurance away first and let them suffer from that.”
Jones, who also spoke about Obamacare with The Daily Signal last month, has a plan through Blue Cross Blue Shield of Kansas City. The company sent Jones a letter in October notifying him that his monthly premiums would increase from $491 to $716 for 2017.
Jones toyed with the idea of changing carriers, but when rates for Missouri were released before the start of the 2017 open enrollment period, the veterinarian learned that his plan would be the cheapest option available.
As a business owner, Jones said he’s looking forward to the impact that repeal of the health care law will have not only on his own wallet, but also on the business community.
Before, many business owners opted to lessen workers’ hours to below 30 hours per week to avoid having to provide them with health insurance coverage. Jones said he also knows of many employees who were forced to watch their hours and income so they wouldn’t lose their subsidy.
But now that Obamacare is likely to be repealed, he sees “cautious optimism” from his fellow business owners:
They’re going to loosen the purse strings a little to make the repairs and make the growth moves that they want to do to improve their business. People have been holding off to see what direction things were going. Now they know what direction it’s going to go.
There are aspects of Obamacare that Jones would like to see included in a replacement plan, such as the measure that allows those under age 26 to remain on their parents’ plan, as well as the provision that prohibits insurers from discriminating against consumers with pre-existing conditions.
But he said he hopes that any new plan would create high-risk pools, expand access to health savings accounts, and do away with the essential health benefits package, a list of mandatory benefits each plan must cover.
“We might be able to have a choice that makes an affordable plan for us, instead of having to take the one-size-fits-all,” Jones said.
Trump hasn’t yet said whether he plans to roll back any of the regulations implemented as part of Obamacare, but Jones said he hopes the new president takes a more piecemeal approach to changing the law, one that would help eliminate some fear among consumers.
“I understand there are people afraid and worried about it now that they have insurance,” he said, “but I don’t think you’re going to run into a heartless decision that jerks insurance away from people.”