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    Obamacare Repeal: What May Replace It

    The Affordable Care Act and its health insurance markets remain intact this year, although not without changes.

    Congress made several unsuccessful attempts in 2017 to repeal the law, also known as Obamacare. But President Donald Trump and his administration have made some changes to the law that will impact this year’s open enrollment. They include:

    • Shortening the time for open enrollment to 6 weeks, from Nov. 1 to Dec. 15.
    • Ending cost-sharing payments to insurance companies that helped low-income Americans pay for insurance 
    • Reducing the advertising budget by 90%

    In the past, the law 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 consumers have found rising premiums and dwindling choices in the health insurance marketplaces. Lawmakers continue to discuss options for fixing what many see as a broken system.

    As they have worked on different proposals, 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.

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    High-Risk Pools

    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.

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