What will happen if ObamaCare is repealed?
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This election season has been filled with twists and turns, and there are probably few people who can say they successfully predicted very much.

That theme is likely to continue for the foreseeable future.


One of the things we can count on based on the results of Nov. 8, however, is, at the very least, a national discussion about repealing the Affordable Care Act (ACA). As a rallying point, the ACA has been a consistent frustration for Republican officials and their constituents.

A near-repeal bill made it to the president's desk in January of 2016 after more than 60 votes for full or partial repeal in the Republican-controlled House, but they failed to make any serious headway.

With control of both houses of the 115th Congress by Republicans, and the election of a Republican candidate for president, change for the ACA seems likely. But what will that look like?

The Likely Template for Change

Republicans will continue to control the Senate after the Nov. 8 election, but they have failed to garner a 60-vote supermajority which would have given them the chance to push through any Democratic efforts to stymie their bills. This means a total repeal of the entire ACA is unlikely, but a motivated Congress can greatly affect several consequential elements.

That near-repeal reconciliation bill was passed by the Senate, passed by the House and vetoed by the President. So given this, it died; but it does give us a good idea of what future efforts might look like. Here are some of the details: future efforts could involve decreased coverage of Medicaid coverage and broad subsidies to help Americans buy their own insurance on new marketplaces future efforts and it eliminate tax penalties for the uninsured, intending to urge everyone to obtain insurance.  

Even though the bill was a reconciliation bill that necessarily has to center on budget items, we can see the main focus of the Senate when it comes to attacking the ACA: funding. Given that subsidies and tax manipulations are part of what makes the "hybrid" system--mixing government programming with the private insurance market--viable, it makes sense that a Republican-controlled congress attacked the ACA at this vulnerability. With a new Republican president to sign-off on that bill in 2017, we might see something very similar coming in 2017.

Potential Limits on a Future Reconciliation Bill

Since reconciliation bills are intended to focus on the budgetary process, they have limited ability to affect parts of the law that are already embedded into other parts of the federal code. As a result, there are parts that likely cannot be repealed through reconciliation, such as the requirement on insurers to sell health policies to individuals regardless of their health history, and also to provide coverage to young adults on their parent's policies through the age of 26.  Since both of those provisions are now part of the Medicare program, they are unlikely to be affected by the reconciliation process. This may create a disjointed healthcare landscape when some of the interdependent elements of the ACA are repealed while others remain. 

The Ultimate Issue

Ultimately, the answer to what might happen with the ACA in the near future is: We will have to wait and see. With a motivated Republican Congress and a newly-elected Republican president that has promised repeal, we know something is likely to happen, but the patchwork of possibilities is very broad.

Keep your eyes open. 

Dr. Anita Gupta is an anesthesiologist, pharmacist and currently a practicing physician in Philadelphia at Drexel University College of Medicine. She is an advisor to the FDA, and currently Co-Chair of the American Society of Anesthesiology Committee on Prescription Opioid Abuse. 

The views expressed by contributors are their own and not the views of The Hill.