The controversial Patient Protection and Affordable Care Act (PPACA) attempted to radically transform America’s medical system, expanding insurance coverage to millions, injecting billions in tax dollars, changing insurance rules, and launching experiments in quality and efficiency. Less of that might disappear under President-elect Donald Trump’s pledge to “repeal and replace Obamacare” than many believe, according to a report from Kaiser Health News (KHN).
“It gets into a question of semantics,” Mark Rouck, an insurance analyst for Fitch Ratings, told KHN. “Are they really repealing the act if they replace it with new legislation that has some of the same characteristics?”
Problems that helped give rise to the act—skyrocketing costs, an aging population, and mediocre medical results—haven’t gone away. The PPACA pushed insurers, hospitals, and employers to launch their own reimbursement reforms, which are largely unaffected by who runs Washington, the article says.
Topping the list of PPACA provisions likely to survive under Trump is the requirement that employers cover workers’ children up to the age of 26, according to analysts. The measure is widely popular and not especially expensive.
A health law crafted by Republicans might also retain the PPACA’s protections for people with pre-existing illnesses seeking coverage, said Glenn Melnick, a health economist at the University of Southern California. That could include relaxing the PPACA’s limit on how much insurers can charge and allowing them to adjust premiums based on an individual’s health, he said. However, that might put the price of insurance out of reach for many.
The PPACA’s payment reforms might also survive in some form. The act prompted hundreds of experiments to control costs by rewarding doctors for efficiency and by fixing payments for episodes of care or for treating entire populations.
Republicans have criticized the Department of Health and Human Services’ innovation lab, which presides over accountable care organizations and many other payment tests. But they may find it more appealing under their own supervision, said Rodney Whitlock, a strategist and former top Republican health advisor in the Senate.
In any case, private insurance companies, hospitals, and employers are likely to continue their own payment reforms, according to analysts.
The PPACA’s biggest coverage expansion came through the Medicaid program for the poor and disabled, which added more than 15 million people. Trump has suggested giving states fixed federal grants for Medicaid, which could lead to a substantial reduction in coverage or benefits. Even partial cuts in Medicaid funding and subsidies for private plans would hurt hospitals, which have benefited from the PPACA’s revenue infusion.
Other aspects of health care will probably stay the same in the near future no matter what Congress does, analysts said.
Source: Kaiser Health News; November 9, 2016.