By Nancy Niles, MPH, MS, MBA, PhD
Author of Basics of the U.S. Health Care System, 3rd Edition
The Affordable Care Act is a very complex healthcare law that resulted in an extensive set of regulations with several deadlines established over the years to implement the act. The Republicans have tried to repeal it for years. I was shocked and dismayed that they had no replacement at hand to repeal and replace. This process is often called 'repeal and delay' because the process can be so lengthy. Obamacare has to be defunded and then replaced with another program. There are already competing bills regarding the replacement. There are many in the majority party worried about the proposed options to replace this system.
The President has indicated that he appreciated some of the mandates such as having health insurance coverage for pre-existing conditions and allowing children to remain on the parents' insurance through age 26. But the remaining mandates that have value to many individuals who have coverage through the Affordable Care Act may be changed. There is great uncertainty.
As a result of this uncertainty, there have been town halls held throughout the country with people very upset about this repeal and replace mantra. There are approximately 20 million or more individuals who have coverage as a result of the ACA. What do you do with those millions of individuals who are both Republicans and Democrats who are afraid they will no longer have insurance coverage. For those individuals, it has become a bi-partisan issue. For that reason, I think it will take 2 years or longer to have a system in place that provides similar coverage for those 20 million plus. What about all of those individuals who now have insurance as a result of the Medicaid expansion in several states? Those in Congress will be worried about their re-elections which may impact this process.
A recent Kaiser Family Foundation national poll, asked Americans what should be done with Obamcacare. After years of consistent dislike of the system by their survey respondents, you would think that an immediate repeal and replace of the law was the most popular pick of respondents -- but you'd be wrong.
Here's how the responses broke down:
- 47%: "No, should not vote to repeal."
- 28%: "Wait to vote to repeal the law until the details of replacement plan have been announced."
- 20%: "Vote to repeal the law immediately and work out the details of a replacement plan later."
- 5%: "Don't know/refused." (Reported February 2017).
Stay tuned. This could be a bumpy ride....
Nancy J. Niles, MPH, MS, MBA, PhD, is Associate Professor at Rollins College in Winter Park, Florida. She is the author of three books from Jones & Bartlett Learning: Basics of the U.S. Health Care System, 3rd Edition, Basics Concept of Health Care Human Resource Management, and Navigating the U.S. Health Care System.