Among the many promises President-elect Donald Trump made on the campaign trail, one seems certain: the repeal of the Affordable Care Act (ACA), or Obamacare.
While the ACA was made law in 2010, it was opposed by then-Gov. Bobby Jindal, who refused to accept the federal Medicaid dollars that would expand the ACA in Louisiana. Gov. John Bel Edwards campaigned on accepting that money, and Obamacare became available to uninsured Louisianans in July. Since then, more than 350,000 residents of one of the nation's poorest and least healthy states have now received health insurance through the program. But it remained controversial, both nationally and statewide.
A 2014 survey by the University of New Orleans Survey Research Center found that one-half (49 percent) of Louisianans "strongly oppose" the ACA, while only 27 percent "strongly approve" of the legislation. But when it came to specific parts of the ACA, those polled were in favor of many of Obamacare's provisions, including the creation of a health insurance marketplace; requiring health insurance companies to cover anyone, even those with pre-existing medical conditions; and requiring that all Americans have health insurance, even if it meant government aid for the poorest.
On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.
President-elect Donald Trump, on his transition website
What the GOP plans to propose as a replacement — and when — are open questions. In an interview with the Milwaukee Journal-Sentinel Dec. 5, House Speaker Paul Ryan said the repeal vote will take place early next year, but "clearly there will be a transition and a bridge so that no one is left out in the cold, that no one is worse off.
"It took them about six years to stand up Obamacare," Ryan added. "It's not going to be replaced come next football season."
An immediate repeal of the ACA would leave 22 million Americans uninsured. Last week, the American Hospital Association and the Federation of American Hospitals sent grimly worded letters to members of the incoming administration, saying that a repeal of Obamacare without a concurrent solution would decimate the American hospital system and have dire consequences for public health. Among the GOP, there are various suggestions for a timeline, including a gradual phaseout that would not take full effect until after the 2018 midterm elections.
The plan largely may lay in the hands of U.S. Rep. Tom Price, R-Georgia, the man Trump has chosen to lead his Department of Health & Human Services. Price, a doctor, has introduced legislation four times to replace Obamacare, and is in favor of a major restructuring of both Medicaid and Medicare. Price and Ryan both like the idea of turning the very popular Medicare into a voucher program, and Price has suggested turning Medicaid into a block grant for the states. Many of his ideas are contained in the Empowering Patients First Act, legislation he has repeatedly introduced in Congress.
On social issues, Price is a favorite of anti-abortion groups for his strong opposition to abortion; Planned Parenthood has called him "an extreme reproductive rights opponent." Price also opposes the requirement that insurance policies provide birth control for women as part of their coverage, seeing it as a threat to the free practice of religion. In a 2012 interview, Price scoffed at the notion that eliminating birth control from insurance mandates would harm anyone: "Bring me one woman who has been left behind," he said. "Bring me one. There's not one. The fact of the matter is, this is a trampling of religious freedom and religious liberty in this country."
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