What to know about the future of Obamacare

The election has ended, and a new President and new Congress will take office in January. Among the most heated issues during the campaign season was the Affordable Care Act, also known as Obamacare.

The law, which was signed in 2010, has faced mixed reviews since its inception, from both politicians and the public.

The most recent Health Tracking Poll from the Kaiser Family Foundation, a nonprofit focused on health policy, found an even split in the public’s opinion of Obamacare. Equal numbers of Americans – 45% – said their view was favorable or unfavorable.

The public never seemed to learn the nitty-gritty of the law, according to Karen Pollitz, a senior fellow at Kaiser.

“People don’t really know that much about the law and how it works, and their understanding is shaped by stuff they pick up here or there on the news or social media,” Pollitz said. “This has been a problem all along with the Affordable Care Act that our tracking polls have just, sadly, documented year after year.”

All the buzz about a possible repeal under President Trump, said Pollitz, has raised even more questions.

To help understand Obamacare today, here are answers to seven common questions.

Will Obamacare be repealed?

Both President-elect Donald Trump and Senate Majority Leader Mitch McConnell have said that repealing and replacing Obamacare is a legislative priority.

In an interview with CBS’s “60 Minutes” after the election, Trump repeated his intention to replace the ACA.

“We’re going to repeal it and replace it,” he said. Though he said his new plan would offer “great health care for much less money,” he did not outline a replacement plan.

Yet, after his 90-minute meeting with President Obama in the Oval Office on Thursday, Trump seemed to be reconsidering this policy, based on remarks he made to The Wall Street Journal.

“Either Obamacare will be amended, or repealed and replaced,” he said, adding that he told Obama he “will look at his suggestions, and out of respect, I will do that.”

The GOP-led House of Representatives has voted to repeal Obamacare multiple times, so most observers believe it will probably do so again.

Despite the firmly stated intentions of Trump and the Republican Party, pulling the plug on Obamacare is “unlikely,” given a probable filibuster by Senate Democrats, Michael Sparer of the Mailman School of Public Health at Columbia University wrote in an article in the New England Journal of Medicine.

Sparer believes Obamacare will undergo major changes, with Republicans repealing significant portions of the law through the budget reconciliation process, which cannot be filibustered. He notes, though, that all of Obamacare cannot be repealed that way.

What would replace Obamacare?

This is not entirely clear, though Trump has outlined some of his intentions on his website and along the campaign trail. According to the plan, Obamacare will be replaced with tax-free health savings accounts. Account funds will be available for use by any family member and can accumulate over time and can be transferred, tax-free, to all heirs.

Trump’s website also indicates that he hopes to create a “dynamic market” by allowing insurers to sell policies across state lines. Those who buy insurance in this market would deduct their premiums on their tax returns.

Under Trump, Medicaid would be managed and administered by individual states and funded by block grants: a fixed amount of federal money. Trump’s website also indicates that he will work with states to establish high-risk pools to ensure access to coverage for people who want it, including those who have not maintained continuous coverage.

Trump’s website notes that he hopes to increase price transparency for health care services and to allow consumers to import drugs from overseas.

It also says the individual mandate must be eliminated: “No person should be required to buy insurance unless he or she wants to.”

“Everybody’s got to be covered,” he said in a “60 Minutes” interview last year. “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

What happens to people with pre-existing conditions?

Obamacare prevents insurance companies from denying coverage to people with pre-existing conditions, such as cancer, or charging people higher or lower fees based on their health status.

At CNN’s GOP debate in February, Trump said he would get rid of Obamacare but maintain the provision that insurers must cover people with pre-existing conditions.

“I want to keep pre-existing conditions. I think we need it. I think it’s a modern age. And I think we have to have it,” he said.

After meeting with Obama, Trump told the Wall Street Journal that he would like to keep the provision forbidding discrimination based on pre-existing conditions.

And this month on “60 Minutes,” he repeated his wish to continue coverage for those individuals.

“It happens to be one of the strongest assets,” Trump said.

What happens to children on their parents’ insurance?

Currently, Obamacare allows young adults to stay on their parents’ insurance plans until age 26.

On “60 Minutes,” Trump said he would try to keep this measure in place if he repeals and replaces Obamacare.

What happens to birth control expenses?

Currently, it is possible to get free birth control under the Affordable Care Act. By law, Obamacare health plans must cover, without charging out-of-pocket fees, at least one type of birth control in each of the 18 Food and Drug Administration-approved categories.

A repeal of Obamacare, then, might imperil women’s access to free birth control unless a replacement continues this provision.

Generally, it is unclear where Trump stands on the issue of birth control. During a September interview on “The Dr. Oz Show,” he said he’s not in favor of requiring a prescription to purchase birth control.

“I would say it should not be a prescription; it should not be done by prescription,” he said.

Notably, despite the fact that the FDA has never approved hormonal contraceptive products for over-the-counter sale, three West Coast states allow pharmacies to sell these products without a doctor’s prescription.

Trump’s website indicates that he intends to remove barriers for drug providers that offer safe, reliable and cheaper products. So this commitment to lower drug costs, combined with Trump’s opinion that contraceptives be available without prescription, could mean low-cost, though not entirely free, over-the-counter contraceptives will be available even if Obamacare is repealed.

When would changes to Obamacare occur?

Sixty Senate votes are required to overcome a filibuster. To reach 60 votes, at least eight Democrats would be required to lend their support to the Republican agenda. Although the Democratic Party says it will not undermine the law, Republicans believe they might be able to convince some moderate Democrats – especially those running for re-election in 2018 in more conservative states – to vote for health care legislation.

Republicans have suggested that passing a replacement bill could take up two years.

“We’re not going to have, like, a two-day period, and we’re not going to have a two-year period where there’s nothing,” Trump said on “60 Minutes” this month.

Should I still sign up for a 2017 plan?

If you have no health insurance and want it, sign up for a plan during the open enrollment period, which runs through January 31.

“It’s available. It’s open enrollment. There are subsidies and people who can help you. All of that is still in place,” Kaiser’s Pollitz said.

Policies and premiums displayed on marketplace websites during open enrollment will be in effect throughout 2017, with plans written for a full calendar year. That said, people are not obligated to continue their policies for a full year. If you got a job with health benefits, say, or if repeal does occur, you would not be required to remain enrolled and continue paying premiums.

However, the plan would be obliged to pay any claims you had incurred up until the time the coverage stopped, explained Pollitz.

Currently, under Obamacare, people who can afford but do not purchase insurance must pay an individual mandate penalty when filing their income taxes. This requirement to have coverage remains in effect, Pollitz said.

“The law is still on the books, and people still get sick and hit by cars, so having insurance is still a good thing,” Pollitz said.