Obamacare Repeal: What May Replace It
Changes are coming to the Affordable Care Act, also known as Obamacare.
President Donald Trump and Republicans in Congress have been trying to repeal the law, which has made health insurance available to roughly 22 million Americans through government-run Marketplaces, expanded Medicaid coverage, and allowing adult children to stay on their parents' health plans.
But with rising premiums and dwindling options, there will be much discussion about health care reform and plans to fix what many see as a broken system made worse under Obamacare.
As they work out the details, Republican leaders have outlined broad policy ideas that may be part of a plan to replace the current law.
Here are some of the terms you are likely to hear as the effort to repeal and replace Obamacare moves forward, along with pros and cons of each.
Before the Affordable Care Act became law, insurance companies were allowed to deny people coverage because of a pre-existing medical condition. In the past, those people may have turned to state-based high-risk pools, which provided health insurance to people with medical conditions such as cancer, heart failure, and kidney disease who were unable to find coverage anywhere else.
High-risk insurance pools were active in 35 states for decades before Obamacare became law. The federal government also operated a high-risk pool for a period before the law’s changes took effect.
Pros: Just 10% of the population accounts for nearly two-thirds of health care spending. Separating people with expensive medical care needs from the broader insurance pool is likely to lower health plan premiums overall, says Linda Blumberg, senior fellow with the Urban Institute.
“If the sick people keep getting moved out and are in the high-risk pool, you don’t share in their cost,” she says.
Cons: Coverage in high-risk pools was very expensive, says Sabrina Corlette, research professor with Georgetown University’s Center on Health Insurance Reforms.
Most states charged 150% to 200% more for premiums in their high-risk insurance program. And they often had waiting periods of 6 to 12 months before covering someone with pre-existing health conditions. Plans included annual and lifetime limits on coverage, and deductibles were very high. Most state programs had to limit enrollment to control costs.