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It will be back to the bad old days for 20 million Americans if US president-elect Donald Trump follows through on his election promises to repeal Obamacare. The scheme, formally known as the Affordable Care Act (ACA), provides health insurance to many who had previously gone without. And depending on which programme Trump replaces it with, tens of millions more could lose out.
“If the campaign promises are acted on, the fate of Obama’s Affordable Care Act is bleak,” says Nadereh Pourat at the University of California in Los Angeles. “The greatest impact is loss of health insurance coverage by about 20 million who gained it through Obamacare.”
Most of those losing out would be poor Americans. “Undoubtedly, the people harmed most by any dismantling of the act are those who gained coverage under the law, mainly lower-income individuals and those with pre-existing conditions,” says Benjamin Sommers at the Harvard School of Public Health in Boston, whose study earlier this year revealed the scale of health benefits arising from Obamacare.
“The evidence is quite clear that the ACA has been very successful at expanding health insurance, reducing the per cent of the population without coverage to its lowest rate in history,” he says. “All this is potentially at risk given the election result.”
Even more people in the US could suffer if Trump carries through on proposals to alter how federal money is allotted to subsidise healthcare.
At present, the subsidies are filtered through the national health insurance system, Medicaid, but with numerous regulations and conditions on how individual states run programmes. Trump has proposed replacing this system with one in which individual states get a block grant, which could simply run out if there are too many claimants.
A detailed analysis in September by research foundation the Commonwealth Fund in New York estimated that repealing the act would leave 19.7 million people uninsured in 2018, almost all on low and moderate incomes.
Instituting a block programme would leave a further 25 million without insurance, and allowing insurers to sell across state lines – currently not permitted as each state has its own insurance guidelines – would maroon a further 17.5 million by depriving them of Medicaid subsidies.
“That would be quite consequential even aside from the impact on Obamacare, since it would affect the more than 50 million Americans with Medicaid coverage before the expansion,” says Sommers.
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