COLUMBIA, S.C. —President-elect Donald Trump and Republicans in Congress say the first thing they want to do is repeal the Affordable Care Act, better known as Obamacare. If they do, it will have an effect on South Carolinians, some positive and some negative.
About 190,000 South Carolinians get their health insurance through the Affordable Care Act, or ACA. State Sen. Joel Lourie, D-Columbia, is also an insurance agent with thousands of clients in three states insured through the ACA. He says it’s helping make many of them healthier.
“About 85 percent of them are getting some federal assistance, and we see that all the time,” he says. “We see a lot of consumers that can buy health insurance and are making much better decisions today than they were maybe two or three years ago. They couldn’t afford it. They might not have been going to get some of the preventive care.”
But if the ACA is repealed, those federal subsidies that make health insurance affordable would likely disappear too, meaning those thousands of people wouldn’t be able to afford health insurance.
“What would happen to those people is a great question, and if they repeal it do they repeal all of it? For example, under the Affordable Care Act 26-year-olds can stay on their parents’ coverage. That’s a great part of the Affordable Care Act that has helped keep our young people covered,” he says.
Another popular part of the law requires insurance companies to cover people with pre-existing conditions without charging more. Before the ACA, they were denied coverage or charged rates they couldn’t afford. Sen. Lourie hopes Congress will find a way to at least keep those parts of the current law in place.
Bob Hartwig, an insurance expert at the University of South Carolina’s Darla Moore School of Business, says if Obamacare is repealed, “There’s going to be significant impact on the nation and, in fact, on the people of South Carolina.”
“What we would hope for in the longer run is that there’d be some restructuring of the program such that it would bring more competition back into the South Carolina market. The only way that is going to happen is to get some more balance in the health care pools that exist today. The pools today suffer from a deficiency of younger and healthier individuals and a surplus of individuals who are older and sicker, and that’s why the plans are, in effect, costing insurers so much money that they’ve been pulling out, including here in South Carolina,” he says.
He expects Congress to repeal the individual mandate, which requires everyone to buy health insurance or pay a penalty. That’s been one of the biggest criticisms of the ACA–that the federal government shouldn’t be allowed to force you to buy something.
Another criticism is that it hurts small businesses and workers. Small businesses don’t have to provide health insurance for their workers if they have fewer than 50 employees, which gives them a disincentive to grow. And some workers are able to get only part-time jobs, or saw their full-time jobs cut to part-time, since employers don’t have to provide health insurance for part-time employees.
Hartwig says the impact of repealing the law will be widespread. “It’s possible that the cost of insurance will go up for certain individuals, particularly if the subsidies are withdrawn or phased out over time. That could be for low-income people or moderate-income people, or people working in small businesses who receive the subsidies today. It’s also going to be the case that individuals who have these chronic conditions, who have the pre-existing conditions are likely to see their rates rise in the future. There’s almost no way around it unless you plan on maintaining the act, and we know that’s not the objective of the new administration.”