In the wake of the election, President Obama’s signature health care law is back in the spotlight. Republicans, including prominent Texans, have wanted to repeal the Affordable Care Act since it was signed into law in 2010. Now, with control of the White House and Congress, Republicans have a better chance than before to dismantle it.
Leigh Kvetko feels a double-duty to stay healthy — for herself, and for the teenage girl whose death gave her new life — in the form of a donated pancreas and kidney.
“I am so grateful,” Kvetko says. “And I try to show that by taking care of myself. I can’t not take care of myself, I’m only here because of her and her family’s sacrifice.”
To stay healthy, Kvetko has to take 10 medications twice a day. Several of the pills cost $1,000 each a month. For years, Kvetko stuck with a corporate job in Austin she hated in large part because it offered health insurance. When the Affordable Care Act passed, insurers could no longer discriminate against people like Kvetko, who have pre-existing conditions, and she and her husband finally felt free.
“It gave me hope and [my husband and I] decided to sell our house, to downsize, and to start our own businesses and start a new chapter of our lives.”
In this new chapter, Kvetko is retail manager at a busy Dallas coffee shop. She struts through the store in cowboy boots, her long red hair framing green speckled eyes. She looks happy, and healthy. But her pancreas is failing, and she’s terrified that a President Trump would dismantle the Affordable Care Act, putting health care out of reach for her, and another 1.2 million Texans who rely on subsidized plans.
Southern Methodist University law professor Nathan Cortez says it’s far too early to make any firm predictions about what is going to happen.
“We’ve heard promises, or threats, depending on your perspective, to get rid of the entire thing,” Cortez says. “There’s a pretty wide range of possible outcomes right now, anything from burn it all down, full repeal, which would be difficult procedurally but nevertheless would be possible, to very subtle changes, in which Republican House and Senate members and President Trump could claim that they’ve repealed it but really just got rid of a few unpopular provisions.”
One of the less popular provisions Trump will likely target is the individual mandate – the requirement that most people be insured or pay a penalty. Republican Congressman Michael Burgess, who's also a doctor, hopes Trump strikes down the mandate.
“As long as the insurance companies understand that you have to buy the product under penalty that is being put on you by the Internal Revenue Service, they’ve got no interest in changing, they’ve got no interest in developing a more cost effective product,” Burgess says.
Burgess and other Texas Republicans have also been critical of the tax credits and premium subsidies available in the health care exchange.
“I think there is likely going to be an orderly transition to something different than what has been structured and called for by the Obama administration,” he says.
The Affordable Care Act is like a game of Jenga
Here’s the thing: keeping the popular parts of Obamacare – like allowing parents to keep their kids on their health insurance plans until the age of 26, or prohibiting companies from denying coverage for pre-existing conditions – those parts of the law have to be paid for somehow.
Law professor Nathan Cortez says the Affordable Care Act is like a Jenga set, if you take out certain parts – like the taxes and individual mandate – the whole thing could collapse.
“It’s hard to cherry-pick certain provisions you don’t like without undermining the entire thing,” Cortez says. “A lot of Republicans might be fine with undermining the whole thing, but if they do that they’re going to be jeopardizing a lot of popular provisions from the act.”
For example, Cortez says, if Republicans get rid of the insurance exchanges but keep the prohibition against using pre-existing conditions as a disqualifier, what’s left is a law that doesn’t allow insurers to deny coverage, but also doesn’t give people like Leigh Kvetko a way to find affordable plans.
While millions of Texans wait for details of the new administration’s healthcare plan, the current period of open enrollment under the Affordable Care Act continues until Jan. 31, 2017.