NEW YORK CITY — The Affordable Care Act, better known as Obamacare, may have an uncertain future under the upcoming Donald Trump presidency, but that doesn't mean New Yorkers shouldn't buy insurance on the state exchange during the current 2017 enrollment period, health policy experts said.
In the final week of his campaign, President-elect Trump vowed to swiftly repeal and replace the health care law that has increased the number of insured Americans by 20 million across the country — including 850,000 in New York state — over the past six years.
“I will ask Congress to convene a special session so we can repeal and replace [Obamacare],” said Trump at a campaign event in Pennsylvania in the week before the election. “And we will do it very, very quickly. It is a catastrophe.”
Then, in a Sunday night interview with "60 Minutes," Trump walked back some of his rhetoric to say he hoped to keep key components of Obamacare, including preventing insurance companies from discriminating against people with preexisting conditions.
He also said there would be no gap in health coverage between when Obamacare would end and his plan would begin.
With Republicans retaining control of Congress and with Trump in the White House, many Americans worried a full repeal of the Affordable Care Act and its benefits would promptly follow.
"That's just plain wrong," said Richard Nathan, former director of the Rockefeller Institute of Government at the State University of New York. "It isn't going to happen in a minute or a stroke of a pen."
Part of the reason lies with congressional rules, according to Professor Michael Sparer.
"The Democrats could filibuster that in the United States Senate and they would," said the chair of the Department of Health Policy and Management at Columbia’s Mailman School of Public Health.
The U.S. Senate's 51-seat Republican majority doesn't have the 60-vote "supermajority" it would require to overcome a Democratic filibuster.
"Republicans will probably use what's known as the 'budget reconciliation' process," Sparer continued, to repeal broad swaths of Obamacare with simple majority votes and no filibustering.
Through budget reconciliation, Republicans can eliminate insurance exchanges, Medicaid expansion and the individual and employer mandates, but they can't touch federal regulations designed to make health insurance more available and affordable.
As for the no-cost birth control offered under Obamacare plans, which has become a focal point of concern for some women online, Sparer said, "My guess is that if there were an effort to cut some basic reproductive health services under the ACA, [U.S. Senator Charles] Schumer and the Democrats would definitely try to filibuster that."
It may take the GOP some time to deliberate over which facets of Obamacare they will repeal and how they might replace them, Sparer said.
And, according to Nathan, Republicans have no intent of pulling the rug of ACA benefits out from under the public's feet in a hurry.
"There's a lot of talk that it's all going to suddenly end and people will lose their benefits and they won't be able — as they have been for now two plus years — to get insurance even if they have pre-existing health problems," he said. "That's not going to happen, and the Republicans who are working on this have made that clear from what they've already done in Congress."
In the meantime, both Sparer and Nathan encouraged New Yorkers without employer-provided health insurance to compare all the options on New York's marketplace and purchase a 2017 plan that best suits their needs during the enrollment period which runs until Jan. 31, 2017.
"Figure out what's best for you and do it," Nathan advised. "Don't wait on changes in Congress or the way the law operates."
The likelihood that New Yorkers would lose coverage in 2017 is "very small," Sparer said.
But Sparer thinks "the combination of price increases and uncertainty about what's going to happen in the next few years, there may be a fair number of young folks who sit this one out again," he said said.
"I hope not," he continued. "I actually think it's better for all, including them, if they sign up" because participation relieves enrollees of penalties and evens out insurance provider risk pools, which have skewed toward older consumers with more health issues.