Obamacare: Looking ahead and not liking what I see

We are barely through the first week of 2017 and The New Unified Republican Government™ has Obamacare in its crosshairs.

I’m not going to pretend that the Affordable Care Act (also known as Obamacare) is without its problems. The very first problem is the “affordable” part. For some, that hasn’t turn out to be the case. Higher premiums were announced last fall, just before the presidential election. Some health insurance companies have opted out of the exchanges, reducing options for coverage.

But Obmacare has yielded some good results, particularly when it comes to access to healthcare.

According to the White House:

• An estimated 20 million people gained health insurance.
• 105 million Americans benefit from the elimination of lifetime and annual limits on insurance coverage and the establishment of annual limits on out-of-pocket spending on essential health benefits.
• As many as 129 million Americans who have some type of pre-existing health condition, including up to 19 million children, can no longer be denied coverage or have their coverage reduced.

This last point is hugely important to people living with chronic illnesses like diabetes.

You see, it used to be difficult to get health insurance with a pre-existing condition. Obamacare changed that. It made it possible (even if it might be expensive) to get health insurance on your own. And this made it possible for people living with diabetes to have some peace of mind.

No longer do people living with chronic illnesses have to worry that if they lose a job or leave a job or move they will be left without health insurance.

No longer do people living with chronic illnesses have to worry that if they end up in the emergency room they, or their families, will end up in financial ruin.

No longer do the lives of people with chronic illnesses have to be determined by their access to health insurance.

This is about to change.

+ + +

“Repeal and replace” is the rallying call among Republicans. But I see a couple of problems with this.

The health care system is vast and complex.

It’s foolhardy to think that you can simply repeal a law that’s taken the better part of six years to implement and everything will be okay. Obamacare touches pretty much everyone in the US in some way.

Repealing it completely will cost the US government $350 billion over the next decade. Hospitals and physicians face uncertainty. Hospitals, especially those providing safety net healthcare services, expect their revenues to drop dramatically. Some healthcare stocks have taken a hit.

No one knows what “replace” means. 

The Republicans have destabilized healthcare in the US by making every aspect of Obamacare uncertain.

There’s a debate about which aspects of Obamacare might be kept. Being able to keep your child on your insurance until they reach 26, removing the prohibitions for pre-existing conditions, and automatic coverage for preventative care have all proved popular.

But can we have these popular benefits without some of the unpopular ones? Like the mandate to have healthcare insurance, for one?

You see, Obamacare was structured so that one part balances out the other. If you chip away at that balance will the financial and structural underpinnings of healthcare in the US be undermined? That remains to be seen, but conventional wisdom says yes.

In the meantime, we’re already starting to hear promises from Republicans and their spokespeople assuring us that no one will lose their healthcare coverage after Obamacare is repealed.

Forgive me for being skeptical.

+ + +