Update 1/20/17: Since this story was published, a lot has happened, and a lot still is not known. Republicans in Congress voted to repeal the Affordable Care Act through the budget reconciliation process, Colorado's Republican congressmen explained their position through an op-ed, people are scared of losing health care and Republicans in the state Senate want to do away with the state health insurance exchanges.
A repeal of the Affordable Care Act, also known as Obamacare, could leave hundreds of thousands of people in Colorado without insurance. There are a lot of details still to be determined, but we'll lay out here how things might change both in the big picture and for individual people.
Will the Republicans repeal Obamacare?
They have said they would, both the president-elect and the party. The current Republican Congress has passed many bills that would have repealed the ACA. President Barack Obama vetoed them.
Trump has promised repeatedly to repeal and replace the law. Odds are good that big changes are coming, and there are so many articles about how that might happen.
We don't know much about the replacement plan, except that Trump wants to allow people to buy insurance across state plans, and Vice President-elect Mike Pence wants to encourage people to put money into Health Savings Accounts.
What happens to my 2017 plan?
Colorado's enrollment period is open now through the end of the year for coverage that starts on Jan. 1, 2017. Insurers generally will be legally obligated to honor those insurance policies and rates through the end of 2017, as Kaiser Health News reported. Trump does have a way he could cut funding for certain subsidies that lower costs for consumers.
By all means, enroll in a health insurance plan now.
The next year, 2018, could be a whole different story. By then major legislative changes might be underway, or insurers may simply be bailing out of a system they see as dying.
"I wish I could give some advice or words of comfort for people, but frankly I just don’t know," said Joe Hanel, an analyst and writer for the Colorado Health Institute.
Would the Medicaid expansion be rolled back?
Currently, about 460,000 people in Colorado are newly covered under Medicaid because of the Affordable Care Act, according to Colorado Health Institute. The Trump campaign hasn't said what exactly it would do with that group, so let me first explain why this is a really big, significant part of the law.
The ACA provided funding to extend Medicaid (insurance for people in need, basically) to groups including:
- Adults without children make less than 138 percent of the federal poverty level, currently $16,400. Previously, adults without children couldn't get Medicaid at all.
- Parents making between 60 and 138 percent of the federal poverty level For a family of four, that's between $14,580 and $33,534. People making less than that were already covered.
The federal government currently sends about $1.5 billion a year to Colorado to pay for the care of those people. If the Medicaid expansion were taken away altogether, "it’s likely they would be without insurance coverage," Hanel said.
"What we saw with the Affordable Care Act is the number of people without insurance in our state was more than cut in half, and that’s almost all due to Medicaid expansion." The percentage of uninsured people dropped from 14.3 percent to 6.7 percent in Colorado, he said.
Of course, people without insurance still show up to get health care in emergency rooms, which is costly for hospitals to provide -- so the loss of insurance for that many people could have some significant secondary effects.
"A big decision that Colorado would need to make, if the ACA is repealed word for word, is what level of Medicaid do we want to offer here," Hanel said. "The trouble with trying to do something funded through the state government is you’re talking about vast sums of money that the state doesn’t have currently."
However, it may also be that the Medicaid expansion is changed rather than reversed. Modern Healthcare suggests that the loss of so much coverage might be too politically daunting. Instead, Trump might pursue the same path as some Republican governors, requiring that recipients are working, searching for work or saving money. That's what Pence did in Indiana.
The Trump administration wants to "maximize flexibility for States in administering Medicaid, to enable States to experiment with innovative methods to deliver healthcare to our low-income citizens," according to the transition site greatagain.gov.
Would people still be required to buy insurance?
The mandate is a crucial part of Obamacare. The financial penalty was supposed to convince young, healthy people to pay into the system. They're not, not in high enough numbers, which is part of why premiums keep rising, according to Hanel.
Would insurers still be required to cover pre-existing medical conditions?
The truth is that no one knows. Trump has said that he wants to continue to force insurance companies to offer insurance for people with pre-existing conditions, but there are strong doubts that's possible without the mandate.
What happens to Connect for Health?
Colorado's insurance-buying marketplace actually could survive the full repeal of the ACA. That's because it was created by the state, not the feds. The incentives that lower the cost of plans for some people would disappear, but Colorado theoretically could maintain the site as a comparison tool for consumers looking at insurance policies.
What about the hospital provider fee?
This isn't directly connected to the ACA, but it's likely on policymakers' minds now.
The state of Colorado collects this fee from hospitals and then collects "matching" money from the federal government. Colorado then gives the money (the federal and hospital money) back to the hospitals, distributing it by a formula to pay for the care of children, people with low income and people with disabilities.
This set-up allowed Colorado to collect some $1.1 billion from the federal government between 2010 and 2015. It's also been criticized as a kind of "shell game," basically rearranging the money -- and the Trump administration will have the power to end it.
"It requires approval from Washington for these provider fees to work," Hanel said. "That’s a big pot of money. If Colorado can keep it, then there’s some possibility of funding Medicaid expansion payments out of it ... if not, then that’s another pot of money that the state would be short. It would affect our Medicaid budget and the budgets of individual hospitals."
What is the state doing?
Not much yet.
"It’s way too early to know what impacts there will be. Obviously, we expect that we’ll have more information and a clearer picture in the months ahead," said Marc Williams, spokesperson for the Colorado Department of Health Care Policy and Financing.
"Our focus, frankly, is implementing current law, and until there is a new law, the ACA, or Affordable Care Act, is current law."
