How defeating Obamacare would reshape America’s healthcare system


The Affordable Care Act does more than allow millions of people to obtain health insurance through trade-ins or expansion of Medicaid.

This saves seniors money on Medicare coverage and prescription drugs. It allows many Americans to get birth control, mammograms, and cholesterol tests free of charge. This forces many restaurants to display the calorie count of their menu items. And it allows children to stay on their parents’ health insurance plans until the age of 26.

Even the Trump administration is using the landmark healthcare reform law to try to lower prescription drug prices.

And especially for many people, Obamacare prevents insurers from denying or charging more for people with pre-existing conditions. This provision has proven to be so popular that even Republican candidates have found themselves promising to defend it in the recent midterm elections in an unsuccessful attempt to retain their majority in the House. According to the Kaiser Family Foundation, some 52 million people, or 27% of non-elderly adults, have a pre-existing condition that would have prevented them from getting coverage before Obamacare.

“You would be hard pressed to find a part of the health care system that has not been affected by ACA,” said Larry Levitt, senior vice president of the foundation, of the Affordable Care Act.

All of this, however, could be brushed aside by a judge in a U.S. District Court in Texas, who ruled on Friday that the Affordable Care Act‘s individual coverage mandate was unconstitutional and therefore the rest of the law could not. be maintained. He seeks to accomplish what Republicans have tried to do for years: repeal Obamacare.

The decision, which is expected to be appealed, does not immediately affect coverage of Americans. But if upheld by higher courts, it could set the country’s health care system back before Obamacare became the law of the land in 2010, when the uninsured rate for non-elderly adults was 18, 2%. It is now 10.3%.

Here’s what’s at risk:

Health Insurance

Obamacare has translated into lower premiums, deductibles and cost-sharing for the roughly 60 million seniors and Americans with disabilities enrolled in the program.

The Health Care Reform Law brought many changes to Medicare. It slowed the growth of payment rates to hospitals and other providers, reduced payments to Medicare Advantage plans, and improved benefits for enrollees. The Obama administration has estimated that the typical Medicare beneficiary pays about $ 700 less in premiums and cost-sharing thanks to the Affordable Care Act.

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Under Obamacare, people enrolled in Medicare also receive free preventive benefits, such as screenings for breast and colorectal cancer, heart disease, and diabetes.

And Obamacare helped close the gap in Medicare drug coverage and was on track to eliminate it completely by 2020. Seniors have to pay more for drugs while they are in the hole. donut, which falls between the initial coverage and catastrophic coverage phases. (The 2018 bipartite finance law accelerated the reduction of the coverage gap until 2019.)

But Obamacare means higher costs for better-off beneficiaries. The law froze the Medicare premium supplement threshold at $ 85,000 for individuals and $ 170,000 for couples, so more people are subject to it. The Affordable Care Act also added a surtax on drug coverage for high-income registrants.

Employer Sponsored Insurance

Obamacare requires businesses with 50 or more employees to provide affordable insurance to their employees who work more than 30 hours per week.

This mandate has not had a major impact on the 150 million workers who are insured by their jobs. Most large employers already provide coverage for full-time workers. However, setting the bar at 30 hours per week prompted some employers to extend coverage to more of their employees, as many companies viewed this threshold as part-time.

In addition, the law allows children to stay on their parents’ plans until they are 26. This turned out to be one of the most popular Obamacare provisions and helped reduce the uninsured rate for this age group.

Workers also no longer have to pay for contraceptives and preventive screenings, such as colonoscopies and mammograms. Obamacare requires that these be provided free of charge.

The ACA also prohibits employers from imposing annual or lifetime limits on benefits and caps on personal expenses.

Obamacare has also had an impact on employees who work in companies with fewer than 50 employees. Insurers can no longer ban workers with pre-existing conditions or ask them to pay more. The law requires plans to cover a range of benefits, including maternity, mental health, and prescription drugs. And it prevents insurers from charging premiums to older workers more than three times those of younger workers.

However, this more comprehensive coverage comes at a price. Obamacare regulations have pushed up premiums, forcing some small businesses to stop offering health insurance to their workers.

Individual market

Obamacare had the biggest impact on the individual market, which was largely unregulated before the health reform law.

The real reason Trump talks about pre-existing conditions

The Affordable Care Act obliges insurers to cover people with pre-existing conditions and prohibits them from charging sick people more. The law ended the practice of insurers imposing annual or lifetime limits on benefits, and it also imposed limits on annual personal expenses. It demands that insurers offer more comprehensive benefits, including drugs, maternity and mental health. It prevents insurers from charging women more and limits premiums for the elderly to three times that of young adults.

Obamacare established health insurance scholarships to allow Americans to purchase individual policies and created federal grants so low and moderate income registrants could purchase policies for less than 10% of their income. It also limits deductibles and co-payments for low-income policyholders.

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Almost 11.8 million people signed up for coverage on Obamacare exchanges for 2018. About 2.5 million Americans purchased individual policies outside of Obamacare exchanges. They cannot apply for grants, but receive all other benefits.

However, many consumers are not happy with the changes Obamacare has made, especially because they have pushed up the premiums. Many middle-class Americans who do not qualify for the subsidies have abandoned their coverage, saying it is now unaffordable.

Some Americans are abandoning Obamacare for cheaper alternatives
The Trump administration has sought to undermine the law by offering alternative coverage – like short-term health policies – that don’t have to adhere to all of Obamacare’s provisions, especially those protecting people with pre-existing conditions. . It also allows states to request changes to their Obamacare programs. The main beneficiaries of these efforts are younger, healthier Americans, who will be able to purchase less comprehensive policies at lower premiums.


Before Obamacare, most people enrolled in Medicaid were low-income children, pregnant women, parents, people with disabilities, and the elderly.

The health reform law opened the program to low-income adults with incomes up to 138% of the poverty line – $ 16,700 for a single person – in states that chose to expand their programs Medicaid. So far, 36 states and the District of Columbia have extended Medicaid or adopted voting measures to do so. Almost 12 million Americans were covered by this provision in 2016, the most recent figures available.
Medicaid expands in 3 red states

As part of the program, the federal government paid 100% of the costs of population expansion for the first three years and is slowly lowering the reimbursement rate to 90%.


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