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When there is a transfer of power, especially presidential power, from one party to another in the United States, the first questions generally revolve around what the new president or controlling party will do about the laws, reforms, and regulations passed by the previous president or party. These questions are especially potent when dealing with controversial or even failing reforms. During the transition from President Barack Obama to President Donald Trump, one of the main questions on Americans’ minds is the next step for the Affordable Care Act (ACA), also known as Obamacare.
In 2010, President Obama signed the Affordable Care Act into law, which brought forth many changes to the United States healthcare system. The goal of the law was to provide affordable, comprehensive, and equal coverage for all Americans; however, most Republicans and some Democrats opposed key portions of the ACA. One major challenge to the ACA was the Independent Business Federation lawsuit against key provisions of the act, including the fine for those who do not have healthcare coverage. The Court ruled in favor of the law, stating that the fine was a tax permitted under the constitutional power of Congress to levy taxes. This ruling upheld key portions of the ACA and essentially ensured that the law would not be completely struck down through constitutional challenge. Other major challenges to the law have been the Hobby Lobby and Little Sisters of the Poor lawsuits against the Obama administration regarding the contraceptive and abortion coverage mandates, which initially did not provide meaningful ways for religious employers, whether nonprofit or for-profit, to invoke religious freedom and moral privilege in order to avoid covering birth control under their employee health insurance plans. Hobby Lobby won its case while the Little Sisters essentially won their case when the Supreme Court unanimously voted to order lower courts to provide accommodation for the Little Sisters’ moral opposition.
Outside of constitutional challenges, the ACA has had numerous economic and logistical challenges since its inception. The healthcare.gov website infamously had technical problems after its launch in the months leading up to the implementation of the mandate in January of 2014, which caused concern and criticism from both Republicans and Democrats. Furthermore, in 2015, Senator Marco Rubio pushed for and inserted a crucial provision into a Senate spending bill that reduced the ability of the federal government to bailout healthcare companies that lost money in the ACA exchanges. These bailouts were known as “risk corridors” and allowed companies to lose money by offering low cost plans and have the shortfall made up by federal taxpayers. The removal of risk corridors caused many healthcare companies to pull out of ACA exchanges and caused a major tangle for the law.
Average Americans are feeling the heat of health insurance reform, too. According to a report by Freedom Partners, insurance premiums have risen by about 28% between 2009 and 2014. This increase is much, much higher than wages rose in that time, and premiums have continued to increase since this report was released in 2015. In 2017, premiums are expected to rise an average of 25%, the largest increase in history. Some scholars attribute this rise in health care costs directly to the ACA, which they consider poorly written and economically doomed to fail. So what’s next?
Throughout his 2016 campaign, Donald Trump campaigned against the ACA, promising to repeal and replace the failing law in its entirety, while still assuring working class Americans that they would be covered. President-elect Trump focused his campaign on attacking the job-killing and unaffordable qualities of the ACA that truly affect every working American, especially in Rust Belt states. Some argue that this strategy may have won him the election.