Republicans Take Major Steps to Weaken Affordable Care Act, Potentially Leaving Millions Uninsured
The landmark healthcare reform law, known as Obamacare, faces significant challenges despite Republican leaders no longer promising its repeal. Instead of directly targeting the Affordable Care Act (ACA), they have focused on eliminating fraud in Medicaid and protecting the program for vulnerable individuals.
This approach has yielded substantial results, with the Trump administration’s domestic agenda package dealing a significant blow to the ACA. The new legislation, colloquially referred to as “the big, beautiful bill,” is projected to leave millions uninsured, raise costs for those remaining in Obamacare policies, and reverse a decade of improvement in the nation’s uninsured rate.
Moreover, the bill aims to shrink Medicaid coverage expansion for low-income adults by requiring them to work, volunteer, or engage in other activities at least 80 hours a month. This change, experts predict, amounts to a partial repeal of the ACA.
The end of 2021 may see further undermining of Obamacare if Congress fails to extend enhanced federal premium subsidies, which were introduced by former President Biden and Democratic lawmakers. The lapse of these subsidies, set for 2025, could lead to skyrocketing premium payments and millions dropping their policies.
Democratic lawmakers are already voicing concerns about the subsidies’ expiration, warning of its potential impact on policyholders. Some Republicans have expressed interest in addressing this matter, particularly considering that residents from Republican-led states would likely be among those losing coverage.
Despite the largest-ever cuts to federal support for health coverage, it remains unclear if the Republicans’ more subtle approach to Obamacare will help them avoid the backlash they experienced during the 2018 midterms, when the repeal effort was a significant factor in Democrats gaining control of the House.
The new law and a recent rule from the Centers for Medicare and Medicaid Services will make it harder to enroll in and renew ACA coverage. They increase verification requirements, hike out-of-pocket costs for enrollees, and prohibit certain legal immigrants from qualifying for federal subsidies.
These changes are expected to result in up to 1.8 million people losing Obamacare coverage next year, with the losses concentrated in seven GOP-led states and North Carolina, which has a Democratic governor. Over time, these provisions are forecast to lead to 2.1 million more people being uninsured in 2034, according to the Congressional Budget Office.
Supporters of the Republicans’ efforts argue that the law and rule aim to eliminate expansions and flexibilities in enrollment and verification, which they claim opened Obamacare up to fraud, primarily by insurance brokers. Critics, however, see these changes as a radical weakening of the Affordable Care Act marketplaces for the next few years.