With only about a month to go until President-elect Donald Trump takes the presidential oath of office, many Americans are guessing at which parts of Trump's campaign promises will be carried into reality. When it comes to the Affordable Care Act, early indications suggest that parts of the landmark healthcare legislation might actually survive a Trump presidency, at least in part. So which parts of Obamacare will Trump leave in place, exactly?
Based on recent remarks, it appears that Trump might maintain the Obamacare provision that forbids insurance companies from denying coverage or discriminating based on pre-existing conditions. The president-elect also referenced a desire to maintain the provision that allows young adults to stay on their parents' health insurance plans until age 26.
This softening stance on Obamacare came only three days after the election. In an exclusive interview with The Wall Street Journal, Trump said that his changing stance on these particular provisions came after his meeting with President Obama in the Oval Office on Thursday. "Either Obamacare will be amended, or repealed and replaced," he told The Journal on Friday. "I told him [Obama] I will look at his suggestions, and out of respect, I will do that." In another interview with CBS' 60 Minutes on Friday, Trump identified the same two pillars of Obamacare — pre-existing conditions and young adults staying on their parents' plan — as two aspects of the healthcare law that he will maintain.
Trump frequently called for repealing and replacing Obamacare while on the campaign trail, so his suggestion that it might be "amended" is certainly a notable change in stance. During the 60 Minutes interview, Trump posited that repealing and replacing Obamacare would occur "simultaneously," telling CBS correspondent Lesley Stahl, "You know, I know how to do this stuff... We're not going to have, like, a two-day period, and we're not going to have a two-year period where there's nothing. It will be repealed and replaced and we'll know. And it will be great healthcare for much less money."
While Trump's bombastic confidence might be reassuring for those who fear the fallout of repealing Obamacare, it appears that this method of picking and choosing which parts of Obamacare to maintain simply isn't realistic. As The Washington Post columnist Steven Pearlstein pointed out in his column this weekend, Obamacare is a holistic system; Taking away one part affects all the other parts. In the case of pre-existing conditions, Pearlstein argues that insurance companies can afford to insure sick people at lower rates only if there is an individual mandate that compels healthy people to buy health insurance.
In turn, the individual mandate is only feasible if there are subsidies for poorer individuals. Pearlstein wrote,
... At the end of the day, once you decide that everyone, regardless of age or medical condition, should be able to buy health insurance at an affordable price, you have essentially bought into the idea that young and healthy people have an obligation to subsidize the older and sicker people in some fashion. And once you do that, it’s sort of inevitable you end up where every health-reform plan has ended up since the days of Richard Nixon. You end up with some variation on Obamacare.
In the earlier days of Trump's campaign, the then-candidate seemed to show a desire — an interest, even — in insuring all Americans. Back in September 2015, when Trump was still campaigning against various other Republican contenders, he said during a 60 Minutes interview that "Everybody's got to be covered... I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now."
There have been indications that Trump's actual understanding of how Obamacare functions is subpar. During a campaign event in October, Trump said, “All of my employees are having a tremendous problem with Obamacare.” This was a confusing statement because Trump's employees are offered company insurance and therefore don't need — and indeed wouldn't be allowed to procure — an insurance plan through the Affordable Care Act. Also in October, Trump told Fox News, "Well, I don't use much Obamacare."
It seems plausible that once somebody tells Trump about how Obamacare works, he'll have more concrete ideas concerning what, exactly, would replace it. As health reporter Sarah Kliff recently wrote in Vox, "Republicans have a strong Obamacare repeal plan. They don't have a strong Obamacare replace plan." For now, what we do know is that Trump has made vague statements about working with states on Medicaid options, implementing more health savings accounts, and allowing insurers to sell policies across state lines, according to CNN.
As for the rest, it's still guesswork for now.