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Obamacare: Has Trump managed to kill off Affordable Care Act? | Obamacare: Has Trump managed to kill off Affordable Care Act? |
(4 months later) | |
The Trump administration has ramped up its attack on the Affordable Care Act by backing a federal judge's decision to declare the entire law unconstitutional. | |
For now, Obamacare is still standing. Around 4.1 million Americans have signed up for new plans so far this year, according to government reports, down 12% from last year. | |
At a rally this week, Mr Trump again promised his supporters: "We are going to get rid of Obamacare." But how much has he delivered on that pledge so far? | |
Repealing individual mandate | 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. | 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 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 | Creating 'skinny' plans |
In 2018, the Trump administration allowed small businesses 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 are meant to appeal to young, healthy Americans, but some AHPs may not cover basics like prescription drugs or maternity care. | |
But in March 2019, a federal judge in Washington DC blocked AHPs on the grounds that they are "clearly an end-run around" to patient protections in the ACA. | |
Shortening enrolment | 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 | 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 | 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. |
Medicaid work requirements | |
The Trump administration has tried to push through work requirements for those using Medicaid - a free healthcare service for low-income Americans - saying it's a way to help end poverty. | |
The policies are state-led and then federally approved. So far, eight states have passed rules requiring many Medicaid users to work, volunteer or train to receive benefits, US media report. | |
On 27 March, a federal judge in Washington DC blocked "arbitrary and capricious" Trump administration-approved policies in Arkansas and Kentucky, punting them back to the Department of Health and Human Services for amending. | |
What's the impact? | What's the impact? |
For now, former President Obama's law limps on. He posted a video last December 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 and regulations 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 baulked at 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 provoked 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 challenged Republicans to work with them 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 liberal Democrats are coalescing around a universal healthcare plan proposed by 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. |
Conservatives say the idea would bankrupt the country, but supporters say Americans would save by avoiding the opaque medical fees they currently face, such as insurance premiums, co-payments, deductibles and other out-of-pocket expenses. | |
A study by the free-market Mercatus Center found Medicare could cost the federal government more than $32tn over the course of a decade. | |
The same research also estimated the plan could save the country $2tn over the same period - but only if healthcare providers accepted a 40% drop in payment rates. | |