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Repeal & Replace Watch

KHN On Call: When Is ACA Repeal For Real?

“KHN On Call” is a new regular feature, a product of our ongoing partnership with NPR. Each week, Julie Rovner, KHN’s chief Washington correspondent, will answer a few audience questions about the new administration’s effort to revamp U.S. health care — to “repeal and replace” the Affordable Care Act. Which changes are real and imminent? What can the president do without congressional agreement? How will policy changes affect patient lives? Tell us what you’d like to know. The segment will air on Morning Edition and we’ll repost the audio and a story here. You can submit questions via Twitter @MorningEdition #ACAchat or @KFFHealthNews #KHNOnCall.

Health care under the Affordable Care Act is poised to change — again. The Republican-led Congress has vowed to “repeal and replace” the health law known as Obamacare.

That has left many people anxious and confused about what will happen and when. So NPR’s Morning Edition asked listeners to post questions on Twitter and Facebook, and we will be answering some of them here and on the radio in the weeks ahead.

Many of the questions or comments that have come in so far have to do with timing. For example, Steva Stowell-Hardcastle of Lewisburg, Pa., said, “I’m confused about what parts of the ACA have been repealed and when those changes take place.”

First, while some parts of the huge health law have been altered since it passed in 2010, nothing substantive has been repealed in 2017.

In January, Republicans in Congress passed a budget resolution that called for major changes to the law to be made in a subsequent bill, called budget reconciliation. That will allow the bill to pass the Senate with only a majority of votes, rather than the 60 votes needed to overcome a filibuster by Democrats. Congressional leaders have yet to unveil what they plan to put in that second bill.

Whatever they include, however, they cannot repeal the entire law in reconciliation. That’s because the budget process limits changes to those that directly affect the federal budget. Put simply, they can modify money but not rules. While there is some debate over how that will look, most people believe the rule that requires insurers to cover people with preexisting conditions could not be repealed through a budget bill.

The Trump administration has taken a few actions, but none making concrete changes — yet. In January, Trump signed an executive order calling for federal agencies to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the act” that would “impose a fiscal burden” on states, individuals, healthcare providers, and others in the health industry.

But so far the only federal action in response to that order has come from the IRS, which decided not to more strictly enforce the “individual mandate” that requires most Americans to have health insurance. The IRS, however, noted that the requirement is still law.

A related question comes from Kathryn Henry of Iowa City, Iowa. She asks, “If it is repealed, what happens to people like me who currently have insurance through it and when?”

Both President Trump and GOP congressional leaders have insisted that they want a smooth transition from the current system to a new one, particularly for the 11 million or so people who purchased coverage on the federal or state health insurance exchanges.

“We don’t want to pull the rug out from under people while we’re replacing this law,” said House Speaker Paul Ryan (R-Wis.) in January. Trump has insisted that repealing the law and replacing it be done “essentially simultaneously,” so as not to leave people without insurance.

Unless something unexpected happens, people who purchased insurance for 2017 should be covered through the remainder of the year.

The bigger question is what happens in 2018. The uncertainty alone is prompting some insurers to get out of the individual insurance market, which is the most affected by the health law.

Insurance company Humana has already said it won’t participate in the health insurance exchanges next year, and the CEO of Aetna told reporters that his company might drop out, too. If Congress deadlocks over how to overhaul the health law, that exodus could accelerate.

Insurers were supposed to tell the federal government whether they planned to participate in the insurance exchanges by May 3, but the Trump administration has now given them until the end of June.

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Insurance The Health Law