Wilton Manors health insurance broker Cliff Eserman has a lot of clients with HIV and AIDS who wouldn’t have health insurance without the Affordable Care Act, better known as Obamacare.
Following the election of Republican candidate Donald Trump, who promised during his campaign to repeal and replace Obamacare upon taking office in January, "most of my people are very scared," Eserman said this week, "because they have a pre-existing condition."
Before the Affordable Care Act was enacted in 2010 under outgoing President Barack Obama, insurers could deny coverage to people with pre-existing conditions. Clients who have come to rely on their Affordable Care Act plan, and the tax subsidies that make it affordable, are now afraid they’ll be denied coverage or won’t be able to afford any coverage that will be available, Eserman said.
"In their minds, they’re going to be thrown off the ACA. A lot of people think they’re being targeted," he said. "They only know the Republicans want to kill it. That’s all they know."
Eserman said he tries to reassure clients by telling them, "I don’t think the ACA can be repealed on its face." But he admits: "I’m not sure whether or not I’m just blowing smoke."
The truth is that no one, including Republican members of Congress who have been trying to repeal the Affordable Care Act since its enactment, knows what will happen after Trump is inaugurated Jan. 20 and after the next Congress is seated.
In an interview Friday with the Wall Street Journal, Trump repeated his pledge to deal quickly with the ACA, while saying he might be open to retaining the ban on denying coverage to people with pre-existing conditions, and to continue allowing children to stay on their parents’ policies until age 26.
Meanwhile, experts say they’re telling consumers to continue signing up for 2017 plans during the current enrollment period scheduled to end Jan. 31.
"We’re telling people that we’re still enrolling for 2017, that we’re still moving forward the way we were," said Jodi Ray, who oversees Florida enrollment outreach at the University of South Florida’s nonprofit Florida Covering Kids & Families program.
Those enrollments represent a contract between insurance companies, the federal government and roughly 20 million consumers nationwide — including 1.2 million in Florida and nearly a half-million in the tricounty region — and it would be highly unlikely for the president or Congress to take any action that would cancel those contracts before they expire at the end of 2017, analysts say.
A more likely scenario, they say, is for Congress and the administration to sunset the most contentious provisions — among them federal tax subsidies and the requirement that everyone must buy insurance — as they hammer out a transition plan.
Florida Blue, a Blue Cross Blue Shield company and the only company offering ACA plans in all 67 Florida counties for 2017, issued a statement Friday saying that Trump’s promise to repeal and replace Obamacare "could not happen overnight."
"The law has been in place for six years and the impact to the 20 million people who now have health insurance under the ACA must be considered," the statement said.
Florida Blue’s mission "to help people and communities achieve better health has not changed and we believe that our goal of providing continued access to quality and affordable health care is one shared by many, including those that will lead and serve in the new administration.
"We intend to work diligently with newly elected federal officials, as well as with our own state legislation, to continue to deliver on our mission."
Repeal of the legislation that made the Affordable Care Act law of the land would require a 60-vote, filibuster-proof majority in the Senate, which Republicans won’t have.
In addition, the ACA is too tightly interwoven with the two other major federal health programs, Medicare and Medicaid, to shut down overnight, Eserman said. For example, the federal government negotiated prescription drug cost savings for people in the Medicare Part D coverage gap — called the "donut hole" — and used those savings to help fund the ACA. Killing the ACA would also kill those Medicare drug cost savings, he said.
Republicans’ likeliest strategy for dismantling its most objectionable provisions would take place through the Congressional budget reconciliation process, said Cynthia Cox, associate director of health reform and private insurance for the Kaiser Family Foundation, a nonprofit, nonpartisan health policy think tank.
Because that process requires just a simple 51-vote majority for passage, it could be used to quickly kill the ACA’s federal tax credits, the individual mandate, and Medicaid expansion, which enabled participating states to extend coverage to people too poor to qualify for Obamacare plans. Florida, under Gov. Rick Scott, did not expand Medicaid, leaving nearly 500,000 residents uncovered, according to the foundation.
Use of the reconciliation process to kill those Obamacare cornerstones would essentially kill Obamacare, Cox said. But it wouldn’t kill the ACA provision that bars insurance companies from denying coverage to people with pre-existing conditions, which would require a filibuster-proof, 60-vote Republican majority or enough Democrats to cross party lines to get to 60 votes.
That’s a problem, experts say, because taking away the requirement that consumers buy health insurance while the pre-existing conditions provision remains in place would saddle insurers with the responsibility to cover the sickest and costliest patients without a guaranteed pool of healthy premium-payers.