Repeal & Replace Watch

KHN On Call: When Is ACA Repeal For Real?

鈥淜HN On Call鈥 is a new regular feature, a product of our ongoing partnership with NPR. Each week, , KHN鈥檚 chief Washington correspondent, will answer a few audience questions about the new administration鈥檚 effort to revamp U.S. health care 鈥 to 鈥渞epeal and replace鈥 the Affordable Care Act. Which changes are real and imminent? What can the president do without congressional agreement? How will policy changes affect patient lives? Tell us what you鈥檇 like to know. The segment will air on Morning Edition and we鈥檒l repost the audio and a story聽here. You can submit questions via Twitter #础颁础肠丑补迟听辞谤 #KHNOnCall.

Health care under the Affordable Care Act is poised to change 鈥 again. The Republican-led Congress has vowed to 鈥渞epeal and replace鈥 the health law known as Obamacare.

That has left many people anxious and confused about what will happen and when. So NPR鈥檚 Morning Edition asked listeners to post questions on Twitter and Facebook, and we will be answering some of them here and on the radio in the weeks ahead.

Many of the questions or comments that have come in so far have to do with timing. For example, Steva Stowell-Hardcastle of Lewisburg, Pa., said, 鈥淚鈥檓 confused about what parts of the ACA have been repealed and when those changes take place.鈥

First, while some parts of the huge health law since it passed in 2010, nothing substantive has been repealed in 2017.

In January, Republicans in Congress passed a that called for major changes to the law to be made in a subsequent bill, called . That will allow the bill to pass the Senate with only a majority of votes, rather than the 60 votes needed to overcome a filibuster by Democrats. Congressional leaders have yet to unveil what they plan to put in that second bill.

Whatever they include, however, they cannot repeal the entire law in reconciliation. That鈥檚 because the budget process limits changes to those that directly affect the federal budget. Put simply, they can modify money but not rules. While there is some debate over how that will look, most people believe the rule that requires insurers to cover people with preexisting conditions could not be repealed through a budget bill.

The Trump administration has taken a few actions, but none making concrete changes 鈥 yet. In January, Trump signed an calling for federal agencies to 鈥渨aive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the act鈥 that would 鈥渋mpose a fiscal burden鈥 on states, individuals, healthcare providers, and others in the health industry.

But so far the only federal action in response to that order has come from the IRS, which decided not to more strictly enforce the that requires most Americans to have health insurance. The IRS, however, noted that the requirement is still law.

A related question comes from Kathryn Henry of Iowa City, Iowa. She asks, 鈥淚f it is repealed, what happens to people like me who currently have insurance through it and when?鈥

Both President Trump and GOP congressional leaders have insisted that they want a smooth transition from the current system to a new one, particularly for the who purchased coverage on the federal or state health insurance exchanges.

鈥淲e don’t want to pull the rug out from under people while we’re replacing this law,” said House Speaker Paul Ryan (R-Wis.) . Trump has insisted that it be done 鈥渆ssentially simultaneously,鈥 so as not to leave people without insurance.

Unless something unexpected happens, people who purchased insurance for 2017 should be covered through the remainder of the year.

The bigger question is what happens in 2018. The uncertainty alone is prompting some insurers to get out of the individual insurance market, which is the most affected by the health law.

Insurance company has already said it won鈥檛 participate in the health insurance exchanges next year, and the told reporters that his company might drop out, too. If Congress deadlocks over how to overhaul the health law, that exodus could accelerate.

Insurers were supposed to tell the federal government whether they planned to participate in the insurance exchanges by May 3, but the Trump administration has now given them until .

Related Topics

InsuranceAffordable Care ActTrump AdministrationU.S. CongressRepeal And Replace Watch

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