More than 3.5 million people were enrolled in the New York State of Health in 2016—the state-run healthcare program under the Affordable Care Act (ACA), widely known as Obamacare.  And there are unusually strong signs of a significant increase in sign-ups for 2017, as people who are worried about losing or being blocked from attaining reasonably priced health care, flock to join.  

Two weeks ago—in the middle of the night—Republican legislators in both chambers of Congress, backed by a zealous president-elect, gutted critical provisions of Obamacare and limited its long-term funding.  

According to the governor’s office, nearly 8 percent (8,000) of Putnam County residents are enrolled in Obamacare, as are 10 percent (95,000) of Westchester residents.  Local governments, doctors and hospitals, patients, and those wanting to ensure a healthy future are fearful that the present healthcare system will be seriously weakened, as more than 20 million people presently enrolled in the ACA (nationally) lose coverage, and millions of others lose their broad healthcare benefits.  

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Long misunderstood and generally considered a handout to the poor, it is only now, with termination around the corner, that middle-class insurees are realizing the possible consequences of cutting billions of dollars in federal healthcare subsidies. There will be much stricter income eligibility requirements, the range and quality of coverage will diminish, and premiums will increase significantly.  

Obamacare brought major changes to healthcare. It created online markets for people who couldn’t obtain healthcare insurance due to pre-existing conditions, for those who couldn’t get suitable coverage through their employer and for those who couldn’t afford to purchase insurance through a private insurer. The law offered subsidies for Americans with lower incomes to help pay their premiums and deductibles.

As Republicans eliminate subsidies, insurance will, again, become unaffordable for tens of millions of Americans. And with fewer people buying coverage, insurance markets will become increasingly unstable. Many insurers will stop offering policies as the customers that remain are going to be sicker than current Obamacare buyers, driving up the cost of insurance for everyone who purchases it. Millions will be forced out of the market and, according to research conducted by the Urban Institute, almost 23 million people will lose their health insurance.

So, what changes are we looking at? Obamacare expanded Medicaid, funding 90 percent of its cost to states, allowing an additional 13 million people—those earning less than about $16,000 for a single person or $33,000 for a family of four—to be covered. 

Obamacare established consumer protections. Insurance companies were prevented from denying coverage or charging a higher price to someone with a pre-existing condition. The law banned setting a lifetime limit on how much an insurer must pay in coverage; it required insurers to offer a minimum package of benefits; it guaranteed preventive health services to be covered without a co-payment; it capped insurance company profits; and it limited how much an insurance company could charge older people relative to younger people. The law also allowed adult children, under the age of 26, to stay on their parents’ policies. 

Obamacare required all Americans to have health insurance, and required companies with more than 50 employees to offer it to their workers. To persuade a sufficient number of healthy people to purchase healthcare insurance, Obamacare provided a wide array of inducements, including: tax incentives to small businesses so that they cover their employees; guaranteed coverage for pre-existing conditions; reductions in unpaid medical bills; a mandate on birth control counseling and free contraception; advice on purchasing the best coverage; preventive-care enticements; a non-discrimination clause; and a policy banning indiscriminate cancellation of coverage.

To pay for the law’s coverage expansion, the Affordable Care Act raised taxes on people with high incomes, prescription drug companies, medical-device companies, and health insurance companies.  It created inducements for hospitals and doctors to successfully improve their quality of care. And for large employers that failed to offer affordable coverage, or individuals who failed to obtain insurance, tax penalties were imposed.

Obamacare required drug companies to report payments made to physicians; it required restaurants to publish calorie counts on their menus; and made it necessary for employers to provide a space for women to express breast milk.

First, the Republicans came for Obamacare. Can Medicare and Social Security be far behind?