Nov. 14--The future of the Affordable Care Act is uncertain.
With a Republican-controlled Congress to remain and President-elect Donald Trump to take office in January, there have been discussions whether the national health care program would be repealed, either in piecemeal fashion or in its entirety.
On greatagain.gov, the incoming presidential administration says it is bound to make some health-care changes.
"A Trump administration will work with Congress to repeal the ACA and replace it with a solution that includes Health Savings Accounts (HSAs) and returns the historic role in regulating health insurance to the states," a statement on the website says. "The administration's goal will be to create a patient-centered health-care system that promotes choice, quality and affordability with health insurance and health care and take any needed action to alleviate the burdens imposed on American families and businesses by the law."
Some aspects of the program simply didn't work as planned, said Antony Davies, associate professor of economics at Duquesne University.
The program was meant to control skyrocketing health-care costs and insure everyone.
"But the cost of private insurance has risen over $1,000 and the cost of employer-provided insurance has risen more than $5,000," Davies said. "As of 2015, 32 million Americans are still uninsured, and an additional 6.5 million are insured not because of the ACA, but because Congress expanded existing Medicare programs."
He said the fact that the program didn't do what it was meant to do was not news to economists. Instead, allowing consumers to choose a plan, similar to choosing auto insurance, might be more effective.
"You can't make everybody happy, but you can make yourself a system with a maximum number of options," he said.
Some may want a no-frills plan; others may want a Cadillac plan that covers everything.
"It's not perfect," Patricia Raffaele, vice president of professional services at the Healthcare Council of Western Pennsylvania, said of the ACA. "We always knew there would be some reforms to it."
However, Raffaele said there are aspects of the program that she hopes would stick, even if other parts were changed.
One thing is eliminating the pre-existing conditions clause that once barred patients from seeking care. Another is allowing young adults up to age 26 remain in parents' health plans.
"There are things in the ACA that we don't think would be repealed because they're positive for everybody," she said.
There are also more than 700,000 Pennsylvanians who have insurance but otherwise would be uninsured without the exchange programs. Approximately 300,000 in the state also enrolled in expanded Medicaid benefits. More than 20 million nationwide use the exchanges for health care coverage.
Neither Raffaele nor Davies expects a complete repeal, nor does Raffaele expect to see major overhaul take effect right away. But what will happen to more newly insured folks who were covered in exchange plans? There have been discussions about states receiving block grants for medical assistance.
"Going from what we have now with medical assistance being a federally funded program ... to becoming a system where the government hands money to the states would be a huge change," Raffaele said. "How would federal government give those grants?"
She said a health spending account that's been discussed wouldn't help most people on exchange insurance programs because they're already in vulnerable financial states, often unable to save money.
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