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p h i l a m e d s o c  .o rg

WHAT'S NEXT FOR THE AFFORDABLE CARE ACT?

feature

What's Next for the

It Didn't Appear to Face a Real Threat...
But Then the GOP Gained Control
of Congress AND the White House
By: Alan Miceli, MA

M

ardi Gras 2017 wasn't supposed to be like this. The
Democrats were supposed to be fat on Fat Tuesday.
Hillary Clinton was the presidential candidate that
polls predicted would be addressing a joint session of Congress on
this night, not Donald Trump. Along with a Hillary win was supposed to come a divided government, with Republicans in control
of the House and maybe the Senate, and a Democrat sitting in
the White House - and the Affordable Care Act sitting pretty for
another four years.
With a Clinton administration, the Republican-controlled
Congress could have reverted to a TV Land rerun of what it had
done during the last six years of the Obama Administration. Back
then it routinely voted to repeal the ACA. Just as routinely, President
Obama would veto the bill and that would be that. The GOP made
its point to voters who wanted repeal, while knowing all along that
the bill would never become law, and Obamacare would live to see
another day.
But things are a lot different now. There's President Trump telling
a joint session of Congress that he wants them to send him a bill
to repeal Obamacare, and another one to replace it. But the road
to those goals has more potholes than the Schuylkill Expressway
in the middle of February, given that Republicans are all over the
map on just what should replace the ACA. And if they don't do it
just right, they jeopardize the health insurance of about 22 million
Americans. The quandary has inspired a joke circulating through
Congress - the GOP plans to repeal Obamacare, then replace it
with the Affordable Care Act.
Trump told Congress he wants an end to the individual mandate
that was designed to force young Americans to buy health insurance,
and in the process, lower the premiums and deductibles for everyone
else. He said it's not working, and the government shouldn't force
people to buy insurance.

He called instead for tax credits that would help Americans pay
for health care premiums, and block grants that the states would
use to fund the health care paid by Medicaid. He said the block
grants would give a flexibility to the states that would ensure that
no one is left out.
The president promised that people with pre-existing conditions
would continue to get guaranteed coverage at affordable rates. He
also pledged to drive down what he called the artificially high price
of drugs.
A Shift in Public Support for Repeal
Members of Congress have faced rowdy town hall meetings
filled with voters demanding that the ACA not be repealed. Those
meetings reflect to some extent the latest polls. A New England
Journal of Medicine survey found that only 15% of primary care
physicians want the ACA repealed. A Fox News poll showed a mere
23% of voters surveyed want a repeal. And when CBS News asked
just Republicans what they thought - 41% sided with repeal, while
53% said fix the ACA.
Harry's Obamacare Problem
A friend of mine is a Democrat who voted for Donald Trump.
He didn't want his name in our magazine, so I'll just call him Harry.
Harry says he does not like the new president, but he voted for him
because, "I can't afford my Obamacare version of health insurance,
and I didn't think Hillary was going to help me."
Continued on page 26

Spring 2017 : Philadelphia Medicine 25


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