President-elect Donald J. Trump recently told the editorial board of The Washington Post something rather unconventional for a person about to hold the nation's highest office. "We're totally predictable," he said. "And predictable is bad."
Trump was talking about foreign policy — but the same holds true for his promises to the American people about overhauling the Affordable Care Act (ACA). In a matter of weeks, Trump flip-flopped from wanting to overturn "Obamacare" altogether, to saying he might keep some of its provisions and get rid of others.
"Real change begins immediately with the repealing and replacing of the disaster known as Obamacare," Trump said at a Nov. 7 rally in Scranton, Pennsylvania. Less than a week later, however, he told The Wall Street Journal that he liked some provisions, including "the prohibition against insurers denying coverage because of patients' existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies."
Regardless of what happens after Trump takes office, Dr. Jeffrey Elder, New Orleans' interim health director, has a message for uninsured residents of the Crescent City: Enroll in the ACA now. Congress has promised to fund the health care policy through the year 2017. The caveat? To qualify for the insurance before Trump settles into the Oval Office, you have to sign up by Dec. 15.
"In Congress, they don't want huge destruction to harm systems already in place," Elder says. "And funding has already been set through 2017. That's pretty straightforward."
Signed into law by President Barack Obama in 2010, and upheld by the U.S. Supreme Court in 2012, the ACA has been a deeply divisive policy, with a Kaiser Health tracking poll just last year finding that nearly as many people — 43 percent — had an unfavorable view of the legislation as those who liked it (41 percent).
On the campaign trail, Trump promised repeatedly to "absolutely get rid of" the ACA, which has been credited with 20 million newly insured (people who have coverage but wouldn't have before), according to the U.S. Department of Health and Human Services. As of Nov. 30, Louisiana enrollment was at 351,000 people — due in large part to Gov. John Bel Edwards' acceptance of federal Medicaid dollars to subsidize the program.
According to the Centers for Disease Control and Prevention, the uninsured rate also hit an all-time low of 8.9 percent this year. Yet Trump has railed repeatedly against the ACA, saying it "tragically but predictably resulted in runaway costs, websites that don't work, greater rationing of care, higher premiums, less competition and fewer choices."
I would say if you could, get coverage now to be covered. It's probably going to be much easier for you in the long term.
– Dr. Jeffrey Elder New Orleans' interim health director
Some of Trump's criticisms are supported by Margot Sanger-Katz of The New York Times, who warned in May that premiums could increase next year by 10 percent or more because carriers may for the first time make costs higher for people with the ACA than those who bought their own insurance beforehand.
When Trump said he wanted to repeal Obamacare altogether, he added he wanted to pay for new insurance by using health savings accounts, which allow people to pay for health care by socking away tax-free income. He also has advocated for insurance companies to sell policies across state lines. Trump has said that will cut costs by promoting more competition.
Dr. Rebekah Gee, head of the Louisiana Department of Health (LDH), declined Gambit's request for an interview. Samantha Faulkner, LDH's press officer, said the office would not take a stance on potential new policies without knowing what they are.
"We will evaluate the position of President-elect Trump as it relates to the ACA," Faulkner wrote in a statement, "and we look forward to working with the president-elect and his administration to address health care, access to care and how it is financed in our state." Faulkner also praised Edwards' measures to enroll eligible residents into Healthy Louisiana, the DHH's Medicaid expansion portal, and helping them access primary and preventive health care.
"Our uninsured rates for health care [for New Orleanians] are at an all-time low," Elder told Gambit. He added that more than 24,000 people in New Orleans had enrolled in the ACA from the marketplace, and since the expansion of Medicaid in Louisiana, an additional 46,000 residents in New Orleans now have insurance. "It means more people have access to primary care services in order to stay healthy," Elder said. "They have a primary care doctor. They go to a family physician. They might not have done that before."
Elder's suggestion regarding the ACA coverage in Louisiana? Get screenings like colonoscopies and mammograms, and do other procedures that help pay for routine health maintenance — to help prevent sickness, rather than try to treat it after it happens.
That's why, he said, the most important action to take before mid-December is for uninsured New Orleanians to sign up for the ACA.
"I can't speculate on what's going to change," Elder said. "But I would say if you could, get coverage now to be covered. It's probably going to be much easier for you in the long term."