"When it happens," she said, "it's something you need insurance for."
Barkley and people like her have benefited in multiple ways from the Affordable Care Act, also known as Obamacare, and its strategies for increasing access to health insurance. One provision, which Barkley has used, allows children to stay on their parents' coverage until age 26. Another forbids insurance companies from denying coverage because of a person's preexisting medical conditions. Another expanded the state-federal
Which of those provisions will survive -- if any -- now that
"The Trump election has created a tremendous amount of uncertainty," said
Anxiety is greatest among Minnesotans with preexisting medical conditions. Before the ACA, insurance companies could simply deny them coverage.
In 2014, after being laid off and losing her employer coverage, she was able to buy a policy using the state's MNsure website, despite her heart condition. When her income dropped, she became eligible for the expanded
Now self-employed, Wagner, 58, expects to move off state coverage, but wonders if private insurers will take her if the federal law changes.
"It is the whole uncertainty that is so unsettling. This surgery is stressful enough," Wagner said. "I hope they don't just abolish the Affordable Care Act and not have something to replace it. There are some problems with the ACA, but there are some good things that come out of it, too."
Trump has mentioned retaining the provision that requires insurers to cover preexisting conditions; Republican lawmakers have said they would address the problem using public "high-risk" pools for people who can't buy private insurance.
Whether that coverage will prove sufficient is "really going to come down to how these risk pools are structured, and how much funding they get," said
The high-risk pool also featured hefty premiums and deductibles in some of its plans. Yet some who used the old program are now nostalgic for it, given the tight limits on doctor and hospital choices, plus skyrocketing premiums, in
In all three areas, Minnesotans face uncertainty, Cox said.
What is known is that
'It's been a disaster'
That has not, however, endeared the law to the public. MNsure suffered computer glitches, long wait times and, this year, skyrocketing premiums. While they affect only a small share of insured Minnesotans -- less than 10 percent -- they gave the law a black eye.
"Survey after survey has shown that [health care] has been not just a primary issue in the minds of voters, but a decisive issue," said Rep.
Whether they liked the ACA or hated it, people who used it seemed rattled by the election. On
"Should I even apply? We have had a couple people ask that question," said
Repeal of the ACA would threaten another key provision -- tax credits that help lower-income people buy coverage in the private market. About 44,000 Minnesotans were receiving those credits as of October, or a little more than half the total buying coverage through MNsure.
Now, with premiums in
"If it wasn't for the subsidy," he said, "we wouldn't be able to afford the insurance."
Republican plans discussed so far include tax credits, and probably would lead to lower premiums in the individual market, particularly for younger and healthier people, Cox said. That's because they would reverse several mandates in the ACA, such as coverage for maternity services and mental health care.
Premiums could also go down as people with preexisting conditions leave the private insurance market for coverage in high-risk pools, Cox said. "If you have skimpier coverage, more healthy people might buy in," Cox said. "The flip side of lower premiums is higher out-of-pocket costs when people use their insurance."
Impact on clinics
Beyond insurance coverage for individuals, the fate of
The impact on these clinics could be compounded if the new president rolls back Obamacare's huge expansion of
Nonetheless, said Holmes at Scenic River, "People expect us to be there. They see the election results but I don't think the impact has trickled down yet, because we don't even know yet what the impact is going to be."
(c)2016 the Star Tribune (Minneapolis)
Visit the Star Tribune (Minneapolis) at www.startribune.com
Distributed by Tribune Content Agency, LLC.