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Sunday, January 21, 2018
HomePolicyAffordable Care ActRepealing the ACA: Response from the Field

Repealing the ACA: Response from the Field


Donald Trump and the Republican Congress have promised to repeal the Affordable Care Act (ACA, also known as Obamacare) and, perhaps, replace it with something else.  After taking office, Trump signed an executive order directing his executive administration to take any steps available to repeal and replace the ACA “to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.”  What this produces is not clear.

Greater clarity on what the new administration and Congress will do was not obvious during the hearings to confirm Tom Price, MD, nominee for Secretary of Health and Human Services, who was vague about what pieces will go and what will replace these. He repeatedly said that they would take actions to provide the American people with more choices and offered approaches such as high risk pools at the state level, catastrophic insurance that he said would be more affordable than what people are getting on the insurance exchanges, and moving Medicaid into a block grant to states. But an editorial in the January 25th New York Times, challenges some of these assertions that new approaches would be better for the American people.

What we know is that the Republicans will repeal parts of the ACA that have budgetary implications through the budget reconciliation process that will occur over the coming months. It is expected that they will undo the individual mandate for everyone to have insurance or pay a penalty. This is one leg of a stool for universal coverage: the individual mandate forces people into the insurance pool who are healthy and are unlikely to use many health care resources, making coverage more affordable for those with health problems. We all are likely to become ill or experience trauma that requires significant health care resources at some point in our lives, so sharing risk all along one’s life is key to keeping coverage affordable and the stool upright. Repealing the individual mandate destablizes the stool.

The Republicans also say they will keep the highly popular requirements that insurers cover people with pre-existing conditions–unless the person has a break in coverage, which can occur when people with limited resources are forced to choose between paying for insurance or paying the rent.

Turning Medicaid into a state block grant is highly likely and will reduce the funds going to states that bought into the expansion of Medicaid coverage to single men and families with higher income levels. It is likely to result in eliminating some people from Medicaid coverage or forcing states to curtail the services Medicaid covers.

These are but a few of the concerns about what will happen to access to health care with the promises to repeal and replace the ACA. The uncertainty surrounding what will happen has increased the levels of stress and anxiety among the vulnerable populations served by HealthCetera co-producer Kristi Westphaln, MSN, PNP, a pediatric nurse practitioner who works in a clinic in Southern California. Kristi shares with HealthCetera producer Diana Mason, PhD, RN, some of the concerns of the families she serves and how she responds to them.

The interview took place on January 17th in San Diego. It airs on Thursday, January 26, 2017, at 1:00 on WBAI, 99.5-FM in New York City. You can listen to the interview anytime by clicking here:

HealthCetera is sponsored by the Center for Health, Media & Policy.



Written by

Diana is a co-director of the GW Nursing Center for Health Policy and Media Engagement and founder of HealthCetera. She was previously president of the American Academy of Nursing. She is senior policy professor at George Washington University and the Rudin Professor of Nursing at Hunter-Bellevue School of Nursing. She is a health policy expert and leader. Diana tweets @djmasonrn.

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