:format(webp)/cdn.vox-cdn.com/uploads/chorus_image/image/51790457/621948960.0.jpg)
Obamacare repeal isn’t theoretical. The potential loss of a reliable safety net is already reshaping Crystal Hall’s life.
Hall lives in Pittsburgh with her husband and newborn daughter. The family has gotten their health insurance for the past year through Healthcare.gov.
“I slept through the final part of the election partially because, with a newborn, I have to sleep when I can,” Hall told me Thursday morning, with her young daughter cooing in the background. “When I woke up and heard the news, the first thing I thought about was health care. That’s what has been worrying me most.”
:format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/7451349/IMG_20161018_202119.jpg)
Hall lost her job at a small nonprofit that didn’t offer coverage two weeks into maternity leave. Her husband is a computer programmer who does contract work. “We’re pretty much the definition of the gig economy,” Hall says. Her daughter is now 10 weeks old, and Hall is starting to look for a new job. Initially, she thought she would go to a small startup or nonprofit.
But Tuesday, everything changed. And now Hall is reorganizing her job search to focus on places that can offer her family health insurance. She doesn’t want to take a job without coverage, only to find that Obamacare’s insurance expansion is eliminated a few months later.
“I’m starting to look now, and now I’m planning to pivot my search,” she says. “I’m glad I had only started looking and hadn’t gotten too far.”
Wednesday night, I put out a call on Twitter asking for people who are worried about losing their Obamacare coverage to reach out to me. I’ve so far received more than 289 responses.
I’ve talked to and emailed with as many of these people as I could over the past day. And the thing I understand now that I didn’t before is this: Obamacare repeal is affecting people right now. Americans who use the law for coverage are experiencing disruption before Trump has taken office or any legislation been introduced into Congress.
These are people like Hall who made certain decisions about their lives based on the Affordable Care Act’s promise that, no matter what, they’d have access to health insurance. They picked certain jobs, lived in certain places, and took certain opportunities on the premise that this promise wasn’t going anywhere.
But Republicans have been quite clear: They plan to break this promise and repeal Obamacare. They also plan to offer a replacement plan, but the party has not yet coalesced around what that will look like. So right now there is no certainty about what health insurance will look like for those who don’t get coverage at work.
And that has people like Hall starting to make plans for a different future, one where Obamacare won’t be around.
One of the emails I received was from Joshua Kelly, who lives in California, who told me about his 2-month-old daughter, Clara. She was born with a heart condition but is healthy now. Kelly and his family have insurance at work; they don’t use Obamacare now. But to him, the law represented opportunity that might now be lost:
If she ever loses health coverage, when she graduates into an uncertain job market, or if she loses her job, the loss of the Obamacare safety net would make it very expensive for her to see a cardiac specialist. This means she won’t be able to take all kinds of risks with her career. The loss of Obamacare will mean a narrowing of her options, and a future with more uncertainty and fear. This saddens me more than I can put it into words.
Obamacare wasn’t perfect — but enrollees say it was certainly better than nothing
The Affordable Care Act has extended coverage to millions of Americans. Ten million have coverage through the marketplaces, and about 15 million have signed up for Medicaid coverage since the health law’s expansion began.
The Medicaid expansion has been a lifeline for Paige Wilson, a 25-year-old college student in Clawson, Michigan. She went without insurance for the first few years of college, and it was tough. She remembers when she had shingles, when she was 19, and ended up selling plasma to afford a $100 doctor visit to get it treated.
“My friends pitched in to pay for the appointment,” Wilson said. “So I was able to go to work, and sold the plasma to pay them back.”
For a while, Wilson’s mom had insurance, and Wilson was able to sign up for that coverage through the Obamacare provision that allows young adults to remain as dependents through age 26. Then she joined Medicaid in January, when Michigan expanded the program.
“My life has turned around with the Medicaid expansion, and that was not even a year ago,” Wilson says. “And now it’s already about to be snatched away from me.”
Before Medicaid, Wilson says she struggled with her bipolar disorder. She didn’t have the money to see a doctor, to figure out what medication might help her. It affected her school work: There were some classes she failed because she was sick for an exam and couldn’t afford to go to the doctor to get a note to explain her absence.
“Professors often require a doctor’s note,” she says. “So I’d be like sitting there deciding between spending $100 or failing the class. And sometimes it’s, like, not life or death, but you just have a stomach bug or a migraine.”
Wilson certainly has gripes about the Affordable Care Act. She can’t find a mental health provider who will take her insurance in the area, so she mostly relies on medication to manage her bipolar disorder.
Lots of Affordable Care Act enrollees have struggled with the plans’ narrow networks, which tend to offer limited doctor choice. Premiums will rise, on average, 22 percent next year — and that will put a strain on many enrollees’ budgets.
The insurance on the marketplaces often is not as good as what group plans offer — but for those who were uninsured before the law, it’s a huge change from having nothing at all.
Wilson is set to graduate from school in April. And now she is also planning to focus her job search on employers that will offer coverage. “If I'm not mentally well enough to work, I won't be able to afford my health care,” she says. “If I can't afford my health care, I won't be mentally well enough to work.”
“The loss of Obamacare will mean a narrowing of options”
James Schulman’s email to me began, “I'm absolutely terrified.” So I followed up to ask more about his situation.
Schulman runs a small marketing company with his wife. They struck out on their own from a larger firm in 2010 — in part because the Affordable Care Act had just ended restrictions on preexisting conditions. Before then, when the Schulmans looked for coverage, they ran into trouble getting coverage for his asthma or her treatments related to surviving cervical cancer years earlier.
“The law definitely played a role,” Schulman says of opening their own business. “We would have probably done it as a side gig if it weren’t there, and kept a job that had insurance.”
The Schulmans still run their own firm. They’ve had two kids since it started: a now 2-year-old son and a 5-month-old daughter. They paid a $1,271 monthly premium for their plan this year. They were one of the families that were having to deal with spiking Obamacare prices: Their premium is set to rise to about $1,800 next year, so they’ll probably switch to a lower-quality plan with a higher deductible.
But the thing they’re worried about right now isn’t the rising premiums. It’s whether they’ll be able to have any coverage at all.
“I like to be optimistic, but we have a family now, and kids come first, and they have to have insurance,” he says. “I don’t really know what we would do.”
Eric Chaney was in a similar situation Tuesday. He started his own financial planning business in 2011, right after the Affordable Care Act passed, because he could finally buy a plan for his family, including his teenage son who has autism.
Chaney’s business has been going well; he’s already hired one partner and was about to bring on another one next week. But then the election happened, and Chaney had to make some quick decisions: Can he really hire this new employee? Should he keep growing this business if he won’t have his health plan in a year or two?
“I’m about to go into this long-term, financially binding partnership,” he says. “And I can’t really do that if there is even a 20 or 30 percent chance that in a few years, I could conceivably be without health insurance and going to have to leave and get a job elsewhere.”
So Chaney spent most of Wednesday afternoon on the phone, trying to figure out what to do. He thought about telling the new partner she shouldn’t join — that the future just looked too uncertain. Finally, he found a solution: A friend of his whom he has known for decades, who owns another financial planning firm, said he could bring his family onto their group plan should Obamacare disappear.
“We have this backup plan in place,” Chaney says. “But it’s not a backup plan that will work for millions of other Americans.”
There are tens of millions of Americans who rely on the Affordable Care Act for health insurance coverage — who aren’t quite sure what the 2016 election, and Republicans’ promises of repeal, mean for them.
We’ve launched a Facebook group for those people to talk about their shared experience. We want this to be a place where Vox readers in this situation can share their stories. From time to time, we’ll ask this group questions about their experiences — some of which might lead to stories. If you’d like to request to join the community, use this link.
