In less than three weeks, Sharita Moultrie has helped dozens of people sign up for health care using a program the incoming Trump Administration vows to repeal.
Since Nov. 1, the community health specialist has been signing people up at the Richland Library for health coverage under the federal Affordable Care Act – also known as “Obamacare.”
However, Republican Donald Trump campaigned on a promise to “repeal and replace” that law and, with an incoming Republican Congress, the president-elect would seem to be in a position to do it.
But Moultrie is telling those she helps not to be too concerned about it.
“What I tell them is: ‘Nothing’s changed,’ ” she said. “The ACA is the law, and that’s not going to change tomorrow or next month.”
Whatever happens with the law after Trump becomes president in January, customers are signing a contract with an insurance company that guarantees them health coverage throughout 2017, explains Moultrie, who works for the library.
But some Obamacare customers clearly were concerned. On the day after the presidential election, 100,000 people accessed online health exchanges nationwide, Moultrie said.
Those anxious customers don’t need to hurry, according to health care economist Lynn Bailey. Republicans have not settled on what to replace the law with and, until they do, it is unlikely the law will be repealed entirely, she said.
“I don’t think it will ever go away,” Bailey said. “You can’t unscramble an egg.”
The 6-year-old Affordable Care Act created state-by-state health-care marketplaces, subsidies to pay for coverage the needy and required all Americans get health insurance coverage or face a tax penalty.
That last item is hugely unpopular. But other parts of the law – allowing older children to stay on their parents’ coverage, or guaranteeing coverage for those with pre-existing medical conditions – are very popular.
Insurers and hospitals are watching the changing presidential ambitions warily.
Regardless of what happens under Trump, insurance companies have an incentive to try to keep the new customers that they signed up under the insurance market places. For their part, hospitals will want their patients to be insured.
An end to ACA-mandated insurance policies could damage hospitals that already expend millions of dollars of “uncompensated care” to needy patients a year, said Rozalynn Goodwin with the S.C. Hospital Association.
“That leads to an increased cost of care across the state,” Goodwin said. If the number of uninsured were to go up, “it would be a challenge, and hospitals are businesses.”
In South Carolina, 317,000 people have health insurance coverage through ACA policies, according to the U.S. Department of Health and Human Services.
Goodwin estimates another 20,000 South Carolinians are eligible for health-care subsidies but haven’t used them. Another 178,000 would be eligible for coverage if the state had expanded Medicaid in line with the 2010 law, according to HHS numbers.
Nationwide, some 20 million have signed up for coverage under the law, a formidable hurdle to overcome before overturning the law.
“No way Congress can just drop 20 million people,” Goodwin said.
Bailey points out Republicans have yet to propose a comprehensive replacement plan for the law. Meanwhile, Trump has said he wants to keep some aspects of the law, including insuring coverage of those with pre-existing conditions and allowing adult children to stay on their parents’ plans until they turn 26.
If insurance companies must cover people who already are sick, they will need to offset those losses with the income from younger, healthier people who ACA required to buy insurance coverage, Bailey says.
Otherwise, Bailey added, “Insurance companies ... will have to charge amazing premiums that nobody can afford.”
One thing Republicans could do is create a low-cost, low-coverage plan for younger people that would be more affordable.
While the health care market may be unchanged for 2017, Bailey expects Republicans will roll out some kind of changes for 2018. Those changes would be reflected in the insurance enrollment period a year from now.
Goodwin said hospital executives are studying a tentative proposal by House Republicans to see what kind of changes could be in the offering.
In the meantime, Moultrie will continue to work with those she helps at the library, trying to find them a health plan in the state’s market place. She and another worker have been “constantly booked” during this year’s enrollment period.
As long as new customers sign up before Dec. 15, their coverage for the year will begin Jan. 1, 2017. The enrollment period continues until Jan. 31. Anyone signing up by then is ensured of coverage starting March 1.
SC and Obamacare
Number of South Carolinians covered by the Affordable Care Act, also known as Obamacare
Number of South Carolinians who did not have health insurance in 2015
Number of South Carolinians who did not have health insurance in 2010, before Obamacare took effect
SOURCE: U.S. Department of Health and Human Services