By Karen Pallarito
TUESDAY, April 2, 2019 (HealthDay News) -- While President Donald Trump's latest push to dismantle Obamacare is on hold for now, millions still stand to lose health insurance if it is ever repealed.
"Vote will be taken right after the Election when Republicans hold the Senate & win back the House," Trump declared late Monday on Twitter.
Just last week, Trump directed the U.S. Justice Department to support a lawsuit aimed at striking down the entire Affordable Care Act (ACA). He predicted Republicans would soon be known as "the party of health care," though he offered no details of a replacement.
By many accounts, there is no GOP consensus on an alternative.
The past week's events have virtually guaranteed that health care would be a core issue in the 2020 election campaign.
Repealing the ACA would have broad implications for health coverage and consumer protections.
Who stands to lose health insurance
It could leave 20 million people uninsured, according to an analysis by the Urban Institute, a Washington, D.C. think tank.
That number includes some who would fall through the cracks if state "Medicaid expansion" plans disappeared, and others who couldn't afford coverage without the financial help they receive under the law.
"We're talking about a potentially chaotic change to the health care system," said health policy fellow Linda Blumberg.
Before Obamacare, insurers could refuse to cover people with preexisting conditions. Most Americans oppose efforts to strip away that protection, Kaiser Family Foundation polling confirms.
Scrapping the law could jeopardize other popular provisions, too. Among those: allowing parents to keep adult children on their policies up to age 26 and removing dollar limits on coverage.
ACA reforms that improved seniors' access to preventive care and closed a gap in prescription drug coverage under Medicare "would also be erased," the Medicare Rights Center and Center for Medicare Advocacy noted in a joint news release last week.
The GOP has led dozens of Obamacare repeal attempts since the law was enacted 10 years ago. The last was in 2017, when Sen. John McCain (R-Ariz.) famously gave a "thumb down" on the Senate floor, spoiling the administration's effort to strip the law of its core provisions.
Court battle continues
Meanwhile, the repeal effort has continued in the courts.
The Justice Department last week filed papers in support of a lawsuit by several GOP-led states. In December, a federal district judge in Texas declared the entire ACA unconstitutional and said it should be invalidated.
The plaintiffs argued that Obamacare can no longer stand because the penalty for not having coverage was removed as part of the Trump administration's tax reform legislation. The mandate was designed to force younger, healthier people to buy insurance to offset the cost and risk of covering older, sicker Americans.
An appeal is pending. But experts said it isn't a sure death knell for the ACA. It could be upheld, or the case could go to the U.S. Supreme Court.
If that happens, the high court might not consider the case anyway, said Joseph Antos of the American Enterprise Institute. But even if it does, consumers shouldn't expect any immediate or radical changes.
"You're going to have an awful lot of Republicans and Democrats lined up against anything extreme that the Supreme Court might come up with," Antos said. "And I think you would see legislation that would make a lot of corrections."
Dave Dillon, a fellow of the Society of Actuaries, said insurers are accustomed to Obamacare lawsuits and repeal attempts, and he's heard no rumblings of insurers poised to leave the marketplace because of this latest push to topple the law.
If something big were to happen before insurers need to file proposed 2020 rates, states would likely allow them to make adjustments, Dillon said.
Health Care Top Issue Among Voters
No matter what happens to Obamacare, Republicans in Congress need to return their focus to health care, said Marie Fishpaw, director of domestic policy studies at the Heritage Foundation.
"It polls as one of the top issues that Americans say they care about," Fishpaw said.
People want lower costs, better choices and the ability to see a doctor when they're sick without losing coverage, she said, adding that Obamacare hasn't been the "resounding success" that some have claimed.
Meanwhile, the Trump administration's own health care proposals face legal hurdles of their own.
A federal judge last month rejected administration rules allowing small businesses and individual proprietors to band together to buy insurance. And another judge blocked Medicaid work requirements that Kentucky and Arkansas planned to implement after getting administration approval.
Even Obamacare advocates acknowledge there's room for improvement. Last week, House Democrats proposed legislation to strengthen the health law by, for example, making coverage more affordable for more people.
"The ACA has done a fairly successful job of getting coverage to a lot of people," Dillon observed, "but the premiums are still a challenge, even with the subsidies."