These are the questions asked myself last year prior to the mid-term elections in which the future of the Affordable Care Act was heavily debated in virtually every national campaign for Congress. I wrote a column about it back then and tried to get candidates and others to address these issues.
The Democrats ran away from Obamacare. The republicans used it like a sword.
They GOP candidates all admitted that favored certain features of the ACA and promised that if they were elected, they would pull Obamacare out by its roots and replace it with a bed of promising healthcare roses.
Strong talk. And it worked.
They were able to tap into the pent-up anger seething for years but probably not a single candidate or journalist or government official questioned what the interim period between repeal and replacement would look like.
But, now, with the Republicans controlling both houses of Congress, the party officials are having a difficult time figuring out what might replace the law after repeal. Some believe the republicans will settle upon modifying the healthcare law and give up the repeal talk, at least until the 2016 Presidential and general elections.
But, what if the pressure to repeal based upon campaign promises rule the day and President Obama is overridden by the majorities in both chambers?
Which again raises the question I have been attempting to ask and to get others to answer—how exactly would this repeal take place assuming Congress overrode the heavy pen of Obama.
It is my opinion that disaster would break out if a repeal plan did not take place simultaneously with a repeal, that insurance companies would immediately balk at paying for pre-existing coverages, states would demand the federal government to continue funding Medicaid expansion and lawsuits would prevail.
So, with that backdrop, towards the end of our Google Hangout interview, I questioned Dr. Georges Benjamin, the Executive Director of the American Public Health Association hoping to get further clarification and maybe even confirmation.
Here is the transcript and video of the interview:
SABLUDOWSKY: and that is the Republican opposition, and right now there is no republican, formal Republican opposition there is a lot of different ideas that are out there, the house when they voted to repeal they basically are asking three House members to come up with recommendations, and my correct?
DR BENJAMIN: While Republicans are trying to come up with that plan to replace the Affordable Care Act and the reason why they having such difficulty is that most of the ideas of the Affordable Care Act or many of the ideas of the Affordable Care Act were originally Republican ideas. And so the health exchange, for example, a Republican idea. Individual mandate came from conservative think tank a lot of the ideas addressing the processes of the program and grants and stuff were conservative ideas, so this is truly as Sen. Landrieu said, was a compromise, a lot of ideas from both sides were put into this, originally, and it is tough with the best ideas have been put together on the table to come up with ideas that are new. Not to be kidding, I wish them well, come up with something that will provide universal healthcare in and affordable way for all Americans and anyone that comes up with new ideas a great plan my organization will certainly look at it and see whether or not it makes sense
SABLUDOWSKY: sure sure. What do you think is the chances that King versus Burwell which is the case that is in front of the Supreme Court might actually impact the mandates? Might actually be a real blow to, Obamacare?
DR BENJAMIN:I believe the Supreme Court will affirm the tax credits in the Affordable Care Act and will rule for the administration and against the plaintiffs which means that the subsidies will stay in place. I can tell you that if they don't, you will have absolute chaos in the insurance industry and I can also assure you that it will not just be limited for those people that are in the Affordable Care Act, it will affect all of our health insurance.
SABLUDOWSKY: Now one of the areas that have really concerned me, and please, you can tell me if I'm wrong, and explain why I'm wrong, but as an attorney, as somebody who has followed politics for quite a while and legislation for quite a while, I basically came across, the thought came to me--just wait a minute, if you repeal Obamacare, if you repeal Obamacare then the law obviously ends, so--what happens to the insurance industry, what happens to the insurance contracts, what happens to the ability to pay for such things as the pre-existing conditions that we all love, that type of protection? hat happens? To me, to me, and tell me if I'm wrong, but to me, the first thing that's going to happen is somebody's gonna go to the hospital and want the insurance to cover it and if it's a pre-existing condition, the insurance company is going to say no, were not covering it because that's no longer the law. Help me, and I wrong about this?
DR BENJAMIN: Well the Affordable Care Act did several things to the broad population--one of the things they made illegal to discriminate based upon pre-existing conditions. They made it illegal for you to deny people access to insurance. They made it permissible for your child to stay on your insurance policy until they were 26 years of age, they made, they put in provisions so that the doughnut hole in a Medicare program went away, the doughnut hole was a place where people were not covered for other prescription drugs at a certain point when they have Medicare coverage. It fixed all those things, and all those things will go back to the way they were 10 years ago and we think that that would be a terrible problem, and we think that the affordable care act fixed that that for many many many people in this country so we think that's a big problem.
SABLUDOWSKY: So, you agree with what I'm saying then, am I correct?
DR BENJAMIN: I practice emergency medicine for many years and I can tell you that the first thing that everybody asked me was--what is your insurance card and I would have problems referring patients to doctors because they would ask, "does this person have insurance" and if the person didn't have insurance, than we would have to try to find someone to take care of them.
We know that people died because they did not have access to care, we know that people who were very sick, were denied insurance and couldn't get care, we know that people put off care because they weren't able to afford their care because they did not have insurance, we would go back to that time
SABLUDOWSKY: Yeah, and so, those insurance policies that were in effect say two years ago are no longer in effect
DR BENJAMIN: Well, we don't know exactly how the transition would occur, I can tell you that the cost to buy insurance will go up and if it's not within the few months, it will certainly be when you renew your policy
So people concerned now about under the affordable care act that there might be some slight increase in costs I can assure you that if something happened to the affordable care act, there would be large increases in cost
SABLUDOWSKY: To me, and I'm not a doomsayers normally, but it seems to me in this type of scenario, you have a law that provides certain protections to consumers, the law no--let's assume that you have a repeal and a veto override, let's just assume, I don't think that's going to happen, but let's just assume that that is what is going to happen because a lot of people are clamoring for it, again assume that happens
DR BENJAMIN: there people clamoring for it but let's
SABLUDOWSKY: sure, I understand, so the law would no longer exist. The policies that were in place a year or two before no longer exist, that was a contract in that contract does not exist, what you now have is a contract between the parties but the underlying funding of each one of these contracts are no longer the same, in fact is totally different. the money that would be used for the tax credits like we just talked about, that money is no longer there--because the law would be repealed, so it just seemed to me that everybody might have a plan and those plans are to be discussed but those plans are three months, a year, maybe a couple of years down the road. in the meantime, if you have a repeal, you can't repeal and say we're going to appeal in six months down the road were going to decide--no because you have this interim period that people get sick and they need coverage insurance companies, the only reason why they have agreed to the pre-existing conditions is because of the pool that you're talking about many many more insurance
DR BENJAMIN right-
SABLUDOWSKY: So so I'm just trying to understand it it makes total logic to me, and as part of the reason why I wanted to
DR BENJAMIN: Think about it this way, what would happen tomorrow, if all of a sudden, all of our car insurance went away, now think about how many car accidents we have every day
DR BENJAMINall those people would be at risk
SABLUDOWSKY: Sure, there's no question, so, so, correct me if I'm wrong, but it seems to me that when the Republicans are putting these programs together and I'm not saying they're wrong to put programs together, because as I think that the affordable care act certainly ought to be fixed in areas that, where, that maybe it might be broken. So, but how in the world are they going to put those plans together--at the same time as the repeal? It doesn't make any sense it doesn't make any sense to me.
DR BENJAMIN: Well, we're a nonpartisan organization so we'll work with anyone who wants to figure out how to both, we would love to figure out ways to improve the affordable care act, there certainly are things that can be fixed and that need to be fixed, clarifications anytime you pass a big piece of legislation like that there are things that need to be fixed. We hope that both sides of the political aisle will get together and work collaboratively to fix those things that need to be fixed. I don't think we need to know a whole new replacement bill. I think we need to fix what we have in front of us and I think that where people have discovered there are flaws--and there are things that need to be fixed, I can tell you that the exchanges and the subsidies, for those exchanges, are not one of them. I think the law was pretty clear that the intent was always to provide those subsidies in those health exchanges. The debate was always here in Washington to have everybody eligible for them whether or not they were state-sponsored or federally sponsored. So I think that's not something that has to be clarified. And, of course the Supreme Court will make a decision on that by June or so of this year, but were firmly believe that the legislative authority was there in the law and it's very clear.
SABLUDOWSKY: Okay, one last question, and that is if you had your druthers and you are actually able to perfect the policy, you're playing the Lord right now, what type of protections would you say, would absolutely, without a question of a doubt, would have to be in the policy
DR BENJAMIN: We would've done Medicare for all. We would've had a single payer system that was Medicare for all. Understand that Medicare for all does not mean there aren't private insurance companies. Because it would work just like the Medicare system, it would allow for private investment, would still have private doctors, you would still have private hospitals but it would work very much like the Medicare system
SABLUDOWSKY: Okay. Well doctor, thank you so much for being with us and I really appreciate your taking the time for us
DR BENJAMIN: Stephen, thank you very much, you have a good day