Zac Schultz:

Even as Republicans debate the future of Obamacare, healthcare.gov says there have been extraordinary demand to enroll in Affordable Care Act plans. In Wisconsin, enrollment is up 14% over this time last year. Those plans cover 2017. But as Frederica Freyberg reports, people are worried about what could happen to their coverage.

Donald Trump:

Real change that begins with immediately repealing and replacing Obamacare, a total disaster.

[Cheers and applause]

Frederica Freyberg:

Ever since the law went into effect, “repeal and replace” has been the clarion call of Republicans, and now with a like-minded Donald trump as president-elect, the Affordable Care Act of today would appear to be toast. That has people who signed up for marketplace health plans that first year it became available watching what’s next with worry. People like Georgia Curry, who aged out of her parents’ plan.

Georgia Curry:

You want to cultivate in your practice.

Frederica Freyberg:

And whose work as a yoga instructor did not provide coverage. She’s been on a mid-tier plan ever since. Paying well under $100 a month because of subsidies calculated by income.

Georgia Curry:

It's really important to me and I'm relatively healthy, but because I do have chronic conditions, I would be nervous to be without coverage, without insurance. It’s important for me to be able to see my doctor. I have a really active lifestyle. I teach yoga, obviously, so my livelihood depends on me being physically healthy.

Donald Trump:

God bless you, everybody. Thank you. Thank you.

[Cheers and applause]

Donna Friedsam:

It is quite evident that the leadership, both the president-elect Trump and the Republican leadership in Congress are intent on fulfilling the promise that was made during the campaign to repeal the Affordable Care Act. But the route to getting there is rather complicated. And it seems that the most recent discussion is being termed repeal and delay rather than repeal and replace.

Frederica Freyberg:

Health policy director at the UW Population Health Institute, Donna Friedsam, says what could be repealed right away are provisions related to the federal budget. So those subsidies would be likely to go. Subsidies which she reports, about 85% of the 230,000 people in Wisconsin covered by the ACA receive. Another provision on the immediate chopping block because it’s linked to tax revenue that supports the law, the individual mandate which requires everyone to have health insurance. We spoke with Health and Human Services Regional Director in the Obama administration, Kathleen Falk about selective repeal of the ACA.

Frederica Freyberg:

Can the president and Congress cherry-pick and keep part of it, like keeping children on health care until they’re 26 or covering pre-existing conditions but ditching things like the individual mandate? Does it work if you just repeal parts of it?

Kathleen Falk:

Well, there will be consequences to repealing any just parts of it. So, for example, if the mandate was repealed, it means all the rest of us who already have insurance will end up paying more because we pay for the health care costs of those without insurance when they show at their emergency room, for example. So there are a lot of people who are affected if you cherry-pick pieces.

Frederica Freyberg:

Including potentially the insurance industry, because if the requirement for everyone to have insurance goes away, but the part of the law that requires coverage for people with pre-existing conditions stays, insurers could wind up with an insurance pool that includes more of the sick and fewer of the healthy.

Donna Friedsam:

I don’t think anybody in Washington in any manner, Republican leadership, is interested in doing something that’s going to collapse the individual insurance market. And so they’re looking for a way to signal to the people that elected them that they are serious about repeal of the Affordable Care Act, but that they need to create enough space and enough time to come up with a solution that is acceptable to the insurance industry and to people such that we won’t have massive losses of insurance coverage that stands today.

Frederica Freyberg:

Among replacement solutions being talked about in Washington on the part of Republican leaders, getting rid of the individual mandate to have insurance, providing tax credits based on age to help buy insurance, expanding the use of health savings accounts, limiting coverage for people with pre-existing conditions to those who have had continuous insurance coverage and phasing out expanded Medicaid. That’s the federal insurance for those at or near the poverty level. On Medicaid, another change would have the federal government give states a block grant or a fixed per capita allotment to manage as they see fit. Right now federal Medicaid money flows to states based on need and demand. In Wisconsin, 1.2 million people are in the Medicaid program.

Donna Friedsam:

I think governors imagine that if they have a federal block grant, they would be able to reduce the spending in the Medicaid program through these kinds of innovations that they have not been able to do with the existing federal requirements. That being said, there is a lot of concern about whether the existing block grant allocations would keep up with the need and demand for the program.

Frederica Freyberg:

There is a lot of imagining going on right now about how to replace Obamacare. And because it’s so complicated to unravel, the replacement may be delayed beyond the full or partial repeal of it. All of the unanswered questions with the clarion call to get rid of the law as backdrop leaves some currently insured under the ACA taking it day by day.

Georgia Curry:

I don’t want the rug ripped out from under me, but I guess I'm just trying to take it a step at a time and see what’s next.

Zac Schultz:

When Georgia Curry renewed her plan to keep it the same as last year, she reports the premiums went up about 60%. The final deadline for those looking to enroll or change plans for 2017 is the end of January.