Prologue:  President Trump celebrated passage of the tax bill by announcing at his cabinet meeting , “When the individual mandate is repealed, that means Obamacare is being repealed.”  The tax bill does repeal the mandate in 2019, ending fines for people who do not have health insurance.  However, every other vital part of the current health care law will remain intact.

Main Facts of Obamacare:  Under the Affordable Care Act, businesses with 50 or more employees must offer health insurance to full-time employees.  Medicaid eligibility was expanded to cover more low-income people.  Young adults under 26, could remain on their parents’ plan.  The law listed certain essential elements:  Prohibited insurance companies from denying coverage or charging higher premiums to people with pre-existing conditions.  Barred increasing costs for older Americans.  Required insurers to provide specified benefits like maternity care and drug addiction treatment. The Medicaid expansion was responsible for insuring more than half of the twenty million Americans who gained health care coverage under Obamacare.

The law created federal and state exchanges for purchasing insurance and gave tax  credits for premiums  purchased on these exchanges.   During the recent enrollment  period  from November 1 to December 15, 8.8 million people signed up for Obamacare through the federal exchange even though the Trump administration had cut the sign-up days in half to lower enrollment. The Trump administration also cut the budget for advertising and reduced grants to navigators  who helped people sign up for coverage.  The 8. 8 million figure was 96% of the 9.2 million people  who selected health plans or were automatically re-enrolled during the last sign-up period.  Joshua Peck, who was the chief marketing officer for HealthCare.gov in the Obama administration said,  “It’s a very, very strong number. It implies that the final week of open enrollment was very big.”

The states with the largest number of sign-ups on the federal exchange  this year were North Carolina (524,000), Georgia (483,000), Virginia (403,000), Pennsylvania (397,000),Illinois (340,000), Texas, (1.1 million), and Florida (1.7 million).  In Florida, more than 700,000 people enrolled or were automatically enrolled in the final week. In Texas, the number was over 550,000. Joshua Peck was correct about the significance of the final week.  The federal numbers do not include the eleven states that operate their own insurance exchanges. They are reporting strong enrollments  with some states extending the time period: January 31 for California and New York;  January 15 in Washington State and January 14 in Minnesota.  

Public support and enthusiasm for Obamacare had been evident during the months of public protest when the Republicans in Congress attempted to pass a Repeal and Replace Health Care bill.   Public outrage at their representatives and senators during  the recess  made clear that Obamacare was very popular with voters.  Hundreds of men and women shouted and waved A.C.A. signs during town meetings. They also told dramatic personal stories of lives saved by Obamacare. The result was that four versions of the Senate bill failed.  Now, it was clear that including repeal of the individual mandate in the tax bill did not deter additional millions of Americans from signing up during the enrollment period.

Epilogue:  Timothy Jost, an emeritus professor at Washington and Lee University School of Law said, “The Affordable Care Act is far more than a mandate, and the repeal of the mandate is by no means a fatal blow. Most of the A.C.A. survives and its coverage will remain.”

……………………………………………………………………………..Joyce S. Anderson