President-elect Donald Trump made "repeal and replacement" of the Affordable Care Act a central talking point in his campaign. Now that he's been elected, analysts and people covered by the act, referred to as Obamacare, are trying to anticipate how Trump's pledge will translate to reality.
Barbara Zabawa fits both those descriptions. She's a Madison-based attorney, heading the Center for Health and Wellness Law - and she's covered by the ACA. Zabawa says you can bet on one certainty in the months to come: change.
"Certainly, it will be different," she says. "How different it will be and what, exactly, will change, still remains to be seen. But I think we have some ideas - we've been able to peek into some windows as to what the future might look like. But the exact way it will look? We don't know yet."
Zabawa says that while change will happen, immediate is a relative term, and so people should plan both for the short- and long-term future. "I think the best course of action would be - if you are dependent on subsidies for health insurance coverage - keep moving forward with the marketplace for now," she says. "If you have some flexibility in your coverage options - if you don't necessary need a subsidy or you don't qualify for one, you can always look outside of the marketplace and go directly to a health insurance company."
Trump and other leading Republicans say they intend to preserve the act's more popular elements, such as mandating coverage for people with pre-existing conditions, and ensuring parents can cover children up to age 26 on their health insurance policy.
But analysts say maintaining those parts of Obamacare will require maintaining a central philosophy of the plan - that younger and healthier people subsidize the coverage for older and sicker enrollees.
"That's community rating, basically," Zabawa says. Eliminating it, she adds, would return the country to pre-Obamacare days. "People were paying more for health insurance if they were older and sicker and those who weren't, paid less."
And again, Zabawa believes major changes will take significant effort - and time. "I think those who are real policy wonks and have looked at the possibilities have said that it's going to take a couple of years to unwind. If they really do away with health coverage under the marketplace, it won't go away immediately, because they [they'd be] leaving tens of millions of people without alternatives."
While she believes change is coming, Zabawa also thinks that one of the legacies of Obamacare may simply be that it moved the ball forward on the effort to ensure everyone has access to healthcare. "I think that - when people think of the Affordable Care Act, we still tend to think of the insurance mechanisms that were enacted as part of it. But there's a whole other side to the law with regard to healthcare delivery and healthcare value," Zabawa says.
"And that piece of it - that we should not pay based on volume, but we should be paying providers based on the value that they offer to the marketplace - that idea, I think, resonates across partisan lines. And it makes sense - why would we pay for something if it's not worth what we're paying for?"
