Normally, this would be the “Year in Preview” column. Frankly, I’m just not ready to gaze into the gathering political storm, particularly since the only bright spots will be lightning from LA Bolts. Instead, I’ll focus on a question I’ve been answering in my day job: “What’s going to happen to my health care?”
If you are lucky enough to have employer-provided insurance, probably not much. Your employer will probably keep providing it as a recruitment tool while complaining that it costs too much. Your contributions and the coverage of your plan will change over time, based on market forces unleashed by whatever happens with the Affordable Care Act, aka Obamacare.
Obamacare recipients likely have a grace period, too. To avoid a Senate filibuster and pass with a simple majority, Obamacare repeal requires a process called reconciliation, which effectively means that any measures included have a financial impact and reduce the deficit. Ending federal subsidies on the exchanges would pass that hurdle, but would leave intact the tax hike that pays for Obamacare and the tax penalties/individual mandate. Even if those can be included, it’s not clear that popular items, like preventing penalties for “pre-existing conditions” or longer access to a parent’s plan can be changed through reconciliation. These issues, much less a replacement plan, weren’t hashed out to every Republican’s satisfaction in the dry run of repeal that Obama vetoed, because they knew Obama would veto it.
Repeal and Delay, the idea of holding a symbolic vote to end Obamacare but leave it in place until the details are figured out, has also hit a few snags. Enough Republican senators to sink repeal have suggested they won’t support it without a clear replacement plan. President-elect Trump has said he wants the replacement to cover more Americans, which wasn’t part of most nascent plans. Insurers, who aren’t required to stay in exchanges, could bolt at repeal knowing there is no long-term revenue, effectively ending any delay to Obamacare’s demise and leaving Republicans on the hook for millions of uninsured Americans.
When changes come to Obamacare recipients, they may largely depend on where you live. One way conservatives like to cut or change benefits is to leave more power to the states, a nod to the 10th Amendment. A state with generally healthy exchanges, like California, might be able to keep them. They could even decide to provide subsidies at the state level. Exchanges with no interested insurers may get no help.
Federalism could be more important to Americans covered by Medicaid expansion. To avoid being blamed for cutting benefits, conservatives like to “block grant” them, often giving the same amount of money with fewer federal rules. States that never took the expansion won’t be affected. A state like California might decide to keep covering the same people, and continue to provide important LGBT benefits, like Pre-Exposure Prophylaxis and hormone therapy. Other states might leave people in the cold or put rules and requirements on benefits.
The long and short: Know your coverage, pay attention and don’t leave California.
