Social policy today 603The Future of “Obamacare” President Trump and the Republican leadership in
Congress have vowed to “repeal and replace” Obamacare. However, they will face
many challenges. First, more than 26 million more Americans had health insurance
in 2018 because of the law: 11.8 million Americans who previously did not have
health insurance have successfully used the exchanges to sign up for insurance,
and more than 6 million young adults have been able to remain on their parents’
health insurance until age 26.^63 Also, 8.8 million new enrollees are covered through
the expansion of Medicaid.^64 Second, many popular parts of the law have already
been in effect since 2010—and these types of benefits are hard to repeal once the
American public recognizes their value. These include a high-risk insurance pool
for adults with preexisting conditions (which includes making it against the law for
insurers of children under 19 years old with preexisting conditions to be dropped
from their parents’ policies); a fix for the Medicare prescription drug plan “donut
hole” (previously, people who spent above a minimal level on drugs but below a high
amount were not covered by the law); and coverage for young adults (up to age 26)
on their parents’ plans. Other popular parts of the law that went into effect in 2013
prohibit insurers from charging co-payments or deductibles for preventive care on
all new insurance plans and prevent insurers from dropping policy holders when they
get sick.
However, President Trump and congressional Republicans have tried to keep the
popular parts while getting rid of the unpopular parts (such as the individual mandate).
It is not clear that this is going to work. If the insurance companies must provide
coverage for people with preexisting conditions but people are not required to buy
insurance, then people will wait until they have some serious condition before they sign
up for insurance, while healthy people will opt out. This means that rates will go up for
everyone, making it even more difficult to get coverage. This appears to be happening
in some markets: premiums for health insurance on the state exchanges are increasing
by double digits, while more than 1 million people have said that they will drop their
coverage now that they are no longer required to have it.^65 Although Republicans agree
on repealing Obamacare, no single Republican alternative has universal support
within the party. Most Republicans have argued for market-based reforms that
would introduce more competition into the system to help keep costs down and for
health savings accounts that would be tax deductible. But the basic problem of how
to maintain coverage for the 26 million people who currently have insurance under
Obamacare has not been resolved.Income support and welfare
When most people think of social policy aimed at helping the poor, they think of
welfare. The earlier section on the history of social policy outlined the evolution
of welfare from a limited policy aimed at helping dependent children of single
mothers to a broader policy directed more generally to households headed by one
person. Welfare is usually thought of as cash support for people who cannot support
themselves. However, income support can take many forms, including food stamps,
unemployment insurance, the Earned Income Tax Credit (EITC), and Supplemental
Security Income (SSI). We will discuss each and then describe the major reform of
welfare in 1996.
The Supplemental Nutrition Assistance Program (SNAP) provides food stamps,
which are government-issued coupons that may be used as cash to buy groceries.
Anyone who has an income that is less than 130 percent of the poverty level andincome support
Government programs that provide
support to low-income Americans,
such as welfare, food stamps,
unemployment compensation, and
the EITC.Full_17_APT_64431_ch16_572-613.indd 603 16/11/18 11:28 AM