Repeal of the ACA… So Now What Should We Do?

Last week marked the inauguration of the 45th president of the United States. No matter your feelings about him or his politics, he’s here to stay, presumably for the next four years, alongside a Republican majority in Congress.

The first order of business? Repealing the Affordable Care Act (ObamaCare), the legislation under which many of us are able to get, and afford, healthcare insurance, and access to the care we need. With the stroke of a pen, the icing on the repeal cake was completed within the first few hours of the new president taking office. Congress had already baked the cake’s layers just a few days before.

The predictions about the effect of this rollback are dire not just for those who depend on ACA insurance, but for all Americans. The non-political Congressional Budget Office estimates 18 million people may lose not just their health insurance, but their ability to get health insurance, too, amid new discussions about pre-existing conditions and high-risk pools.

We hear those politicians say they plan to improve the situation, that insurance will become more affordable, that they won’t take away the ability of Americans to access care. Lots of talk, but so far nothing that looks like a real, implementable plan. Just lots of speculation.

So what are we left with?

The status of healthcare delivery in America has never been in such a state of flux as it is today.

Whether or not you are insured through the ACA yourself, whether or not you have clients who are insured through the ACA, as health and patient advocates we have to ask ourselves, “So what should we do now? How do we help our clients? How does this change our services?”

Here is what we DO know:

  • We do know there will be changes that will affect all citizens, whether or not they have insurance through the ACA.
  • We do know that the president cannot repeal the ACA by himself. Only Congress can.
  • We do know that no aspect of the profiteering healthcare system will back down on its profit-producing activities. No matter the changes to the law, every individual and organization who makes money from the system today will figure out how to maintain or increase that profit.
  • We do know that no matter how the politicians try to spin it, the new plan will cost all of us more, whether we’ve had insurance through the ACA or not. The Congressional Budget Office says insurance prices will add 20 to 25% to premiums – everyone’s premiums (not just ACA premiums). It’s like whack-a-mole. If you lower one aspect of the pricing, then another goes higher: premiums, co-insurances, co-pays, or taxes. And we ALL pay taxes.
  • We do know that more babies may be born because repeal of the law will mean that even though coverage for Viagra will remain, coverage for contraception may no longer be required (except in New York State.)
  • We do know that no matter what the effects, positive or negative, the new president will define them as “terrific” and “beautiful” because he already has – to the press, on Twitter, and elsewhere.

Here is what we DON’T know (yet):

  • We don’t know any details about what Congress will do to replace the ACA. They say they have plans, but so far the only plans made public don’t cover everyone, and shift even more expense to taxpayers. And even among Congressional Republicans, there is little agreement.
  • We don’t know how much more it will cost us. See above.
  • We don’t know the ripple effects or unintended consequences. Examples: How many more people will die because they can’t gain access to the care they need? or, How many more teachers and government workers will be laid off (because retired teachers and government workers and other pensioners have contracts that bake in their insurance – so their state governments will have higher insurance costs to bear on their behalf, which will require cutting existing, working staff to pay for it – OR – raising taxes higher. See above.)
  • We don’t know how many more doctors will decide to leave the profession because they can’t be fairly reimbursed. That will make it even harder for many patients to find doctors (and for advocates to find doctors for their clients.)

Here are some potential situations and problems advocates need to watch for and discuss with clients, all of whom will be affected, whether or not they have relied on the ACA:

  • All insurance – not just insurance issued through the ACA – will be in flux.
  • Do not assume that a doctor who accepted one’s insurance before today will accept it again. “In network” and “out of network” are changing almost minute-to-minute. (That’s not new. It has been true for years.)
  • Never assume that lab tests, procedures, prescriptions or other orders will be covered, no matter how “good” one’s health insurance. Never assume that any part of a hospitalization will be covered. Just because it was covered yesterday does not mean that it will be covered today or tomorrow or next week.
  • Do not assume subsidies for those who get their insurance through the ACA will stay intact. Clients who have had the cost of their insurance subsidized in whole or in part may see that disappear, depending on the state they live in and the reason for their subsidy.
  • Do not assume that if someone already has insurance for 2017 that it will stay intact even through 2017, much less in future years.
  • Do not assume that clients with pre-existing conditions will be able to keep insurance at all.

The Bottom Line for independent Advocates

Ironically, ONE aspect of all the change that is about to occur is a positive one for our profession. That is, that the need for patients to have an advocate to assist them on their journey through the system will become even more vital.

The more the system is in flux, the more confused patients become, the more fearful they are that they can’t get what they need at a price they can afford, the more job security for independent health and patient advocates.

Those are the reasons our profession got started to begin with. Each passing day brings more proof that we are on the right track. Health and patient advocacy is a profession that’s time has come.

Every problem brings an opportunity, and now is our time to thrive.

Are you prepared? Do you have all your practice ducks in a row? Marketing, contracts, other professionals, and the resources in place so you can serve the clients who will need you?

Prepare for problems, flux, confusion, and frustration – and the opportunities that result.

Resources to Share with Clients:

Resources for Advocates and Those Who are Considering a Step Up to This Profession:


4 thoughts on “Repeal of the ACA… So Now What Should We Do?”

  1. I think all advocates should read this article and consider signing the petition on ENDING PREDATORY HEALTHCARE PRICING in America. We, as advocates, should know better than anyone that there is plenty of swamp draining to be effected in healthcare and insurance. How can we NOT be for such an idea seeing as we experience it firsthand and are forced to maneuver through it everyday, seeing how it affects our lives and those of our clients? This repeal COULD and SHOULD be considered as a true opportunity to change this paradigm.
    In the words of Buckminster Fuller… “Never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”

    Christina deMoraes

  2. Another great blog post Trisha! As a profession our clients hire and look to us to provide this information. Having up to the minute correct information, even knowing it will continue to change, is critical. Equally important is to not become part of the hysteria. Chicken Little comes to mind. Our clients depend on our ability to be rational and level headed.

  3. Except for the comment “And we ALL pay taxes”, which has been proven wrong by/for people in power and corporations galore, this is the grim but accurate representation of where America stands: profit over care for all, greed over compassion and mere humanity.
    The pool of potential clients is huge however how many will be able to afford our services, and what tiny percentage actually knows about our existence? The need for education is great, and for spreading the word about rights, options and solutions through advocacy or the application of patients’ rights, even if these are disappearing like snow under spring.

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