Following the manic scramble by the House and Senate, urged on by President Trump, to “repeal and replace” the Affordable Care Act (also called the ACA or Obamacare), and the failure of those efforts it’s now a good time to reflect on what has and hasn’t been done, the potential future of Obamacare, and any possible impact on international students. If you want a spoiler, the answer is that as far as international students and scholars go, just like the majority of Americans, very little is likely to change.
Ever since its passage in 2010, the Affordable Care Act (also called the ACA or Obamacare) has been the favorite political punching bag of Republicans. Even after around 20 million people are newly insured as a result of the ACA, throughout the 2016 Presidential Campaign repealing Obamacare was a top priority of now-President Trump, driven by the desperate partisan desire to eliminate any landmark legislation associated with President Obama. The complexity of such a task was lost in the campaign rhetoric though, particularly as so many voters now rely on the ACA for their health coverage. Even President Trump wanted to keep the “popular” parts of the ACA – mainly ensuring pre-existing condition coverage for everyone and extending coverage to those who otherwise cannot afford it – while eliminating the “unpopular” parts – mainly the mandate that requires every US citizen, permanent resident or resident alien to purchase ACA qualifying coverage. The problem in such an approach is obvious to those with insurance experience.
In order to provide the popular parts – pre-existing condition coverage and affordability – you absolutely need the unpopular part – the individual mandate. In order to keep stabilized rates, you need everyone in the system, young and old, healthy and sick, rich and poor – so that the costs of providing care to all Americans is spread amongst all Americans. If you remove the mandate, young and healthy people will opt out of coverage, leaving an insurance plan in a death spiral, as it incurs more and more claims, gets more expensive, pushing more healthy people out. Insurance companies, for one, will not go along with any plan to eliminate the mandate while still providing comprehensive coverage.
Congressional Republicans tried several times this summer to come up with something that could work, to no avail. There was not really a substantive policy discussion – for the most part, Republicans are boxed in by their promise to repeal Obamacare, when really what it needs is some bi-partisan fixing. The good news is, that seems to be what’s happening now. There are on-going bi-partisan (yes that means Democrats and Republicans working together!) efforts to ensure stability in state health insurance markets and keep access affordable. No one thinks the ACA is perfect, but when repealing it is not an option, it’s time for our Congressional leaders to work together and fix the parts that need it.
Our analysis from several years ago still applies, the majority of international students are exempt from the ACA, and only those who have become “resident aliens” by remaining in the US for over 5 years need concern themselves with the ACA. With a big legislative agenda that will need a lot of focus, and after this summer’s failures, repealing the ACA is unlikely to happen.