This article is from the source 'bbc' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at https://www.bbc.co.uk/news/world-us-canada-24370967
The article has changed 3 times. There is an RSS feed of changes available.
Version 0 | Version 1 |
---|---|
Obamacare: Has Trump managed to kill off Affordable Care Act? | Obamacare: Has Trump managed to kill off Affordable Care Act? |
(3 days later) | |
With the deadline upon us to buy Obamacare coverage for the coming year, national data shows fewer people are enrolling than before. | With the deadline upon us to buy Obamacare coverage for the coming year, national data shows fewer people are enrolling than before. |
Around 4.1 million Americans have signed up for new plans so far this year, according to government reports, down 12% from last year. | Around 4.1 million Americans have signed up for new plans so far this year, according to government reports, down 12% from last year. |
President Donald Trump promised to dismantle his predecessor's landmark 2010 healthcare law. So, to what extent has he succeeded? | President Donald Trump promised to dismantle his predecessor's landmark 2010 healthcare law. So, to what extent has he succeeded? |
Repealing individual mandate | |
Congressional Republicans last year finally succeeded in repealing the Obamacare requirement that people buy health insurance or pay a tax penalty. | Congressional Republicans last year finally succeeded in repealing the Obamacare requirement that people buy health insurance or pay a tax penalty. |
In December 2018, a federal judge in Texas ruled that the repeal of this "essential" part of the law meant the entirety of Obamacare is therefore unconstitutional. | |
The law, however, remains in place as an appeal heads to the US Supreme Court. | |
The mandate was not as successful as Obamacare's architects hoped in driving younger, healthier Americans into the healthcare marketplace. | The mandate was not as successful as Obamacare's architects hoped in driving younger, healthier Americans into the healthcare marketplace. |
Now, as they ditch their coverage, analysts say insurance firms are making up for the loss by charging more to the sick or medically vulnerable patients left behind. | Now, as they ditch their coverage, analysts say insurance firms are making up for the loss by charging more to the sick or medically vulnerable patients left behind. |
Creating 'skinny' plans | |
In 2018, the Trump administration allowed insurance companies to offer Americans cheaper, less-comprehensive policies called Association Health Plans (AHPs) that last only up to a year. | In 2018, the Trump administration allowed insurance companies to offer Americans cheaper, less-comprehensive policies called Association Health Plans (AHPs) that last only up to a year. |
Since AHPs are short-term, companies can charge higher premiums or deny coverage based on medical history and pre-existing conditions, which Obamacare made illegal for long-term plans. | Since AHPs are short-term, companies can charge higher premiums or deny coverage based on medical history and pre-existing conditions, which Obamacare made illegal for long-term plans. |
These skimpy plans will appeal to young, healthy Americans, but some AHPs may not cover basics like prescription drugs or maternity care. | These skimpy plans will appeal to young, healthy Americans, but some AHPs may not cover basics like prescription drugs or maternity care. |
Shortening enrolment | |
Initially, users had 90 days to sign up for insurance on the federal marketplace. | Initially, users had 90 days to sign up for insurance on the federal marketplace. |
In 2017, the Trump administration cut it down to 45 days, and then closed the website every Sunday for 12 hours, citing maintenance. | In 2017, the Trump administration cut it down to 45 days, and then closed the website every Sunday for 12 hours, citing maintenance. |
Slashing ads and budgets | |
Funding for the "navigator" programme, under which trained individuals or organisations help people sign up for insurance through Obamacare, has dropped from $62.5m (£48m) to $10m under President Trump. | Funding for the "navigator" programme, under which trained individuals or organisations help people sign up for insurance through Obamacare, has dropped from $62.5m (£48m) to $10m under President Trump. |
His administration has also cut Obamacare advertising spending to $10m - a 90% reduction. | His administration has also cut Obamacare advertising spending to $10m - a 90% reduction. |
According to a November 2018 Kaiser Health poll, 61% of Americans aged 18 to 64 said they did not know about any enrolment deadlines. | According to a November 2018 Kaiser Health poll, 61% of Americans aged 18 to 64 said they did not know about any enrolment deadlines. |
Ending cost-sharing reduction payments | |
Insurance companies who covered lower-income Obamacare patients used to get cost-sharing reduction (CSR) payments from the US government. | Insurance companies who covered lower-income Obamacare patients used to get cost-sharing reduction (CSR) payments from the US government. |
When the Trump administration cancelled these payments in October 2017, insurance firms increased premiums to compensate for the loss. | When the Trump administration cancelled these payments in October 2017, insurance firms increased premiums to compensate for the loss. |
The end of CSR payments had little effect on lower-income Americans, who still receive other healthcare subsidies. But it did lead to a cost hike for patients who pay full-price for their medical coverage. | The end of CSR payments had little effect on lower-income Americans, who still receive other healthcare subsidies. But it did lead to a cost hike for patients who pay full-price for their medical coverage. |
What's the impact? | What's the impact? |
For now, former President Obama's law still stands - and he keeps fighting for it. He recently posted a video urging uninsured Americans to register. | For now, former President Obama's law still stands - and he keeps fighting for it. He recently posted a video urging uninsured Americans to register. |
A 2018 government report saw 11.8 million Americans re-enrol in Obamacare plans, and 27% were new users. | A 2018 government report saw 11.8 million Americans re-enrol in Obamacare plans, and 27% were new users. |
It was around 400,000 fewer people than in 2017 - a smaller figure than expected given the Trump administration's efforts. | It was around 400,000 fewer people than in 2017 - a smaller figure than expected given the Trump administration's efforts. |
Average premiums have nearly doubled since 2014. | Average premiums have nearly doubled since 2014. |
A Gallup poll earlier this year found 55% of Americans worry "a great deal" about accessing and affording medical care - the fifth year in a row that healthcare has topped the issues list. | A Gallup poll earlier this year found 55% of Americans worry "a great deal" about accessing and affording medical care - the fifth year in a row that healthcare has topped the issues list. |
Gallup also reported the adult uninsured rate had dropped to a record low of 10.9% in 2016, but has since risen to 12.3% post-Trump. | Gallup also reported the adult uninsured rate had dropped to a record low of 10.9% in 2016, but has since risen to 12.3% post-Trump. |
What does the existing law do? | What does the existing law do? |
The Patient Protection and Affordable Care Act, known as Obamacare or the ACA, was the largest overhaul of the US healthcare system since the 1960s. | The Patient Protection and Affordable Care Act, known as Obamacare or the ACA, was the largest overhaul of the US healthcare system since the 1960s. |
It aimed to eventually slow the growth of US healthcare spending, which is the highest in the world. | It aimed to eventually slow the growth of US healthcare spending, which is the highest in the world. |
Obamacare intended to extend health insurance coverage to the estimated 15% of Americans who lacked it and were not covered by other health programmes for the poor and elderly. | Obamacare intended to extend health insurance coverage to the estimated 15% of Americans who lacked it and were not covered by other health programmes for the poor and elderly. |
The law created state-run marketplaces - with websites akin to online shopping sites - where individuals can compare prices as they shop for coverage. | The law created state-run marketplaces - with websites akin to online shopping sites - where individuals can compare prices as they shop for coverage. |
Some of the more popular provisions include: | Some of the more popular provisions include: |
'Don't take away our healthcare' says Trump country | 'Don't take away our healthcare' says Trump country |
Why do conservatives oppose the law? | Why do conservatives oppose the law? |
Republicans say it imposes too many costs on business, with many describing it as a "job killer". However, since the implementation of Obamacare jobs in the healthcare sector, at least, rose by 9% and a 2017 study found that around 2.6 million jobs could be lost by 2019 if it is repealed. | Republicans say it imposes too many costs on business, with many describing it as a "job killer". However, since the implementation of Obamacare jobs in the healthcare sector, at least, rose by 9% and a 2017 study found that around 2.6 million jobs could be lost by 2019 if it is repealed. |
Conservatives have also decried the act as an unwarranted intrusion into the affairs of private businesses and individuals. | Conservatives have also decried the act as an unwarranted intrusion into the affairs of private businesses and individuals. |
They have also argued against Obamacare's rule requiring most companies to cover birth control for free. | They have also argued against Obamacare's rule requiring most companies to cover birth control for free. |
The Trump administration tried to put in place new guidelines for organisations to opt out on moral grounds last year, but two federal judges blocked the move. | The Trump administration tried to put in place new guidelines for organisations to opt out on moral grounds last year, but two federal judges blocked the move. |
During the Obama presidency, the Republican-controlled House of Representatives took dozens of symbolic votes to repeal the law and forced a partial government shutdown over the issue. | During the Obama presidency, the Republican-controlled House of Representatives took dozens of symbolic votes to repeal the law and forced a partial government shutdown over the issue. |
After repeated legal challenges, in 2012 the US Supreme Court declared Obamacare constitutional. | After repeated legal challenges, in 2012 the US Supreme Court declared Obamacare constitutional. |
Despite having a majority on Capitol Hill under President Trump, a Republican repeal bid failed in dramatic fashion in 2018. | Despite having a majority on Capitol Hill under President Trump, a Republican repeal bid failed in dramatic fashion in 2018. |
Democratic leaders have acknowledged Obamacare is not perfect, and have previously offered to work with Republicans to fix its flaws. | Democratic leaders have acknowledged Obamacare is not perfect, and have previously offered to work with Republicans to fix its flaws. |
Obamacare v Republican plan compared | Obamacare v Republican plan compared |
Where Trump went wrong on healthcare | Where Trump went wrong on healthcare |
The big US election issue that's not Trump | The big US election issue that's not Trump |
What about 'Medicare for All'? | What about 'Medicare for All'? |
Growing numbers of left-wing Democrats are coalescing around a universal healthcare plan proposed by former Democratic presidential candidate Bernie Sanders. | Growing numbers of left-wing Democrats are coalescing around a universal healthcare plan proposed by former Democratic presidential candidate Bernie Sanders. |
He advocates expanding Medicare, the US government's medical coverage programme for pensioners, to all Americans. | He advocates expanding Medicare, the US government's medical coverage programme for pensioners, to all Americans. |
Mr Sanders' idea - Medicare for All - would provide healthcare for everyone free of charge. He says it would be funded by higher taxes. | Mr Sanders' idea - Medicare for All - would provide healthcare for everyone free of charge. He says it would be funded by higher taxes. |
The plan's champions say its tax burden on Americans would be offset by savings in an array of often opaque medical charges they currently face, such as premiums, co-pays, out-of-pocket expenses and deductibles. | The plan's champions say its tax burden on Americans would be offset by savings in an array of often opaque medical charges they currently face, such as premiums, co-pays, out-of-pocket expenses and deductibles. |
Mr Sanders has cited a figure from a libertarian study suggesting Medicare for all would save the US $2tn on healthcare spending over a decade. | Mr Sanders has cited a figure from a libertarian study suggesting Medicare for all would save the US $2tn on healthcare spending over a decade. |
But the research, by a pro-free market think tank, said that estimate was based on hospitals and doctors accepting payments of 40% less for patients who currently have private insurance. | But the research, by a pro-free market think tank, said that estimate was based on hospitals and doctors accepting payments of 40% less for patients who currently have private insurance. |
The study projected that if current rates stay around the same, American healthcare spending could increase by more than $3tn under Medicare for All. | The study projected that if current rates stay around the same, American healthcare spending could increase by more than $3tn under Medicare for All. |