Popular Provisions of Affordable Care Act in Danger if ‘Fundamental Bargain’ is Broken, MU Expert Says

January 23rd, 2017

The views and opinions expressed in this “for expert comment” release are based on research and/or opinions of the researcher(s) and/or faculty member(s) and do not reflect the University’s official stance.

COLUMBIA, Mo. – President Donald J. Trump’s first executive order was signed Friday, urging his administration and Congress to dismantle the Affordable Care Act (ACA) and replace the federal health law, citing runaway costs, higher premiums and other issues. At the same time, Trump has promised to keep certain provisions of the law, such as barring insurers from denying coverage to individuals with preexisting conditions and the elimination of lifetime coverage caps. However, health care law expert Sam Halabi, associate professor of law at the University of Missouri, said it will be difficult for lawmakers to pick and choose popular aspects of the law while eliminating foundational provisions of the ACA.

“The fundamental bargain of the ACA was that insurers would take on more sick people in exchange for more healthy people enrolling,” Halabi said. “If only one half of the bargain is kept, no insurer would offer a policy without some kind of legal compulsion or financial incentive in its place.”

Halabi says it is too early to know who will “win” and “lose” upon repeal of the law.

“The big losers might be those who obtained coverage through the Medicaid expansion, so mainly the poor or those close to the Medicaid threshold under the ACA – currently around $33,000 for a family of four,” he said. “The next big losers would be people who could not afford individual policies pre-ACA, but who could with the generous tax subsidies the ACA put in place.”

Halabi joined MU in 2017 and is a Scholar at the O’Neill Institute for National and Global Health Law at Georgetown University. His research focuses on national and global health law with a specialization in the governance structures of firms in health-related sectors.