But health care experts say an immediate decapitation of the health care law, also known as Obamacare, is unlikely and impractical as tens of thousands of Michiganders (and many more nationwide) have already begun shopping on the Healthcare.gov marketplace for 2017 individual market coverage that will kick in
Any big change affecting those getting coverage under the ACA is more likely to take effect for 2018, these experts say.
What's more, it does not appear that Trump favors a full repeal of the polarizing law. During the campaign, he repeatedly voiced a desire to keep some of the more popular parts of Obamacare. . On Friday, he told the
?Related: For better or worse, Trump has promises to keep in
Republican leaders have pledged to repeal Obamacare because it's a new government entitlement that requires everyone to have health insurance coverage or face a tax penalty, among other mandates. It also relies on tax credits and subsidies to lower the price for lower-income participants.
But supporters say the mandate to participate -- including requiring businesses with 50 or more full-time workers to provide employee health insurance -- is the only way to ensure the viability of the marketplaces.
The tension underscores the extreme challenge for any policymaker in keeping the popular parts of Obamacare and paying for it without killing its intent, to provide health insurance for tens of millions of Americans who otherwise would be uncovered.
Aside from the government-run marketplace, about 625,000 low-income Michiganders now enjoy a basic level of health coverage through
Many hospitals statewide want the expansion to remain in place as it helps their bottom line. They previously received no reimbursement when these newly eligible individuals lacked insurance and showed up in their emergency rooms.
"From a policy standpoint, both of the initiatives have been incredibly positive for the community we serve,"
However, experts say
This revamp -- a recurring idea among some conservatives -- would ostensibly save money for the federal government by discontinuing its open-ended
Trump and Vice President-elect
But experts say it would be a policy challenge to retain just the popular parts of the ACA -- call them the Best of Obamacare -- while ending the taxes, government subsidies and the nationwide mandate that everyone show proof of health insurance or pay a tax penalty.
The penalty started off small but is now either
Eliminating the Obamacare mandate, penalties and Healthcare.gov subsidies would likely worsen the problem of rising health plan premiums for individual coverage because that would mean fewer young and healthy people signing up, experts say.
More than 80% of
Should the individual mandate and subsidies go away, "then you get into the death spiral, where the only people who end up enrolling are people who are sick, and that will drive (insurance) prices up," said
Intent of the law
An analysis by the
Even though some politicians blame the health care law for recent double-digit premium increases, the ACA was primarily designed to expand insurance coverage to more people -- not contain the ever-rising costs of health care.
Large annual premium spikes were common in the years before the law took effect, as were unpopular lifetime and yearly coverage limits in some plans that the law banned.
It is not yet clear how a Trump administration working with the Republican-controlled
Reconciliation was used to pass the ACA in 2010 after former Republican
"It is easy to repeal," said
No blueprints after repeal
Trump's team has yet to unveil any blueprints for an Obamacare replacement. He and Pence cited a few "free market reforms" during campaign stops, such as tax-free health savings accounts, the
In one of the more detailed speeches, Pence lambasted the premium spikes happening with policies sold on Healthcare.gov -- "we've got to pull it off the market so it stops burning up our wallets." He criticized the high-deductible plans that prevail on the ACA marketplace. The deductibles for such plans can exceed
The incoming vice president noted how people who buy high-deductible plans often avoid going to the doctor due to the out-of-pocket expense.
"What good is a health care plan if you can't afford to use it?" Pence said in the
"I know -- it's insane," he said last week. "I haven't even gone to the doctor since I signed up. I just did it to avoid the penalty and for the peace of mind."
How can costs be contained?
Missing so far from Trump and Pence are explanations on how rising premiums could be reined in even as the individual mandate to buy insurance would go away. Experts say this conundrum is why few Obamacare replacement plans have been put forth.
"That's why you have the individual mandate -- so you can pay for all this," professor Jacobson said. "They have never been able to say how they pay for it. And if you're not paying for it, that means higher premiums."
Last week's historic election has been a boon so far for ACA enrollment. The Obama administration announced that more than 100,000 people signed up for a marketplace plan on Wednesday, the most of any day since the current enrollment period started.
Dizzy Warren, executive director of Enroll Michigan, which assists people in signing up for Healthcare.gov plans, said her staff has been fielding questions about what a Trump presidency could mean for the ACA.
"But it is not at a panic level," Warren said. "We understand that this is not an overnight action and there is not any information out there to be able to advise consumers on anything."
The likelihood of repeal is already nerve-racking for
They previously had
"I am very concerned because it is going to impact him," he said. "To what degree, I don't know."
Contact JC Reindl: 313-222-6631 or [email protected]. Follow him on Twitter @JCReindl.
What could be in Trumpcare?
* Prohibition against insurers denying coverage to those with pre-existing conditions.
* Allowing adult children stay on parents' insurance until age 26.
* Tax-free health savings accounts.
* Letting individuals deduct premium payments from their taxes.
* Allowing insurers to sell products across state lines.
* Greater price disclosure by health care providers.
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