Students graduating with degrees from the Department of Nursing and Health Sciences will be faced with a health care system in potential transition as a result of the repeal and replacement of the Affordable Care Act (ACA).
According to the University of Miami’s Fact Book, as of fall 2016, there were 912 students in the School of Nursing and Health Studies, 589 of them undergraduates.
For Miguel Hernandez, a sophomore public health major, the repeal and replacement of the ACA is an opportunity to modify some of the law’s requirements, an effort he hopes to be part of upon graduation. The son of a mother insured through the ACA, he said a repeal would give him more drive.
“I want to improve health care, so I definitely think it would motivate me more,” Hernandez said. “I’d want to bring it back or do something more to improve the system.”
The ACA, a health care reform plan conceived and signed into law in March 2010 by former President Barack Obama, has been locked in the sights of Republicans for a repeal since its installment. President Donald Trump has promised to repeal the ACA, nicknamed “Obamacare,” within the first 100 days of his presidency.
Under the ACA, an estimated 20 million Americans have obtained health insurance coverage since 2010. More than 1.6 million people enrolled in Florida, with 600,00 enrolling in Miami-Dade and Broward counties alone. In Hialeah, a city in northwest Miami-Dade County, a total of 12,330 residents signed up; this was the largest number of registrations through the Healthcare.gov website in a single ZIP code.
However, the number of people insured throughout the United States is not the only variable the ACA has increased exponentially. According to the Pew Research Center report in 2015, job growth in the health care sector since the implementation of the ACA has spiked, with over 1 million new jobs created. Some of those jobs created could be at risk of being lost if the ACA is repealed.
Karoline Mortensen, an associate professor in the School of Business Administration who specializes in Health Sector Management and Policy, said a large component of the ACA was the expansion of the health care system as a whole – the ACA gave “hundreds of millions of dollars” to federally qualified health centers to increase the number of centers and providers.
If the Trump administration repeals the ACA but does not replace it with a similar comprehensive alternative, job losses in health sectors could be as high as 2.9 million, Mortensen said.
“They have to be very careful in how they disrupt the system,” she said.
Though Hernandez said he knows there will be job losses upon a repeal, he said he isn’t fearful of unemployment because a repeal would give him more to do as a future policy maker.
“It wouldn’t really affect my career or future. I’ll have a job. Repealing it will give me more jobs,” Hernandez said.
For Alyssa Mirante, a nursing school senior who will be graduating in May 2017, a repeal could complicate her goal of working in an emergency care unit. She said the increase in medical coverage around the country has encouraged more and more people to schedule preventative visits with their primary doctors to avoid trips to the emergency room.
Mirante said, with a repeal, emergency rooms would have an increase in patients with non-life threatening illnesses because more people would avoid regular doctor visits. She said having more people insured is beneficial for both medical practitioners and their employers. With more money coming in from those insured, hospitals would be able to afford to take better care of their staff and employ more people, Mirante explained.
“The more people who have insurance, the more likely I am to get paid and not overworked and overstressed,” she said.
Since the ACA’s implementation, Republicans in Congress have tried to repeal portions or the entirety of it more than 60 times during Obama’s presidency. In January 2016, one of the bills to repeal the act passed through Congress and ended up on Obama’s desk. He vetoed it.
“Because of the harm the bill would cause to the health and financial security of millions of Americans, it has earned my veto,” Obama explained in a video following the decision.
Now, with a Republican-controlled White House, House and Senate, a repeal is likely to happen within the first two years of the Trump presidency, before some senators and representatives are up for re-election in November 2018. However, a repeal does not mean that the law will necessarily be replaced.
Despite a potential repeal affecting the job field she will be entering in a few months, Mirante said she’s interested to see what lies ahead for the health care system and her employment.
“I am hopeful that we are going to reach some form of health care in the future, I don’t think it will be a catastrophic meltdown; we’ll just go back to old patterns. I am more hopeful than scared,” she said.
Associate Professor of Political Science, Gregory Koger, who specializes in legislative processes and political parties, said, though it would be hard to predict what Republicans will do with their current leverage, a repeal without a replacement is not out of play.
“For six years they promised to repeal and replace. They never figured out what they wanted to replace it with and that was fine, as long as Democrats were always allowed to block them,” he said. “Now that it’s actually a reality that they have the power to repeal and propose a substitute, they have no idea what they want to do.”
In a recording leaked to the Washington Post, Republican Congress members are heard discussing their concerns regarding the repealing of the ACA and its repercussions despite vowing for years to do so. Members also seemed worried about how a repeal and replacement could affect their chances of winning in the mid-term elections.
“We’d better be sure that we’re prepared to live with the market we’ve created,” said California Congressman Tom McClintock in the recording.
Koger said Congress is able to pass portions of a repeal, which could include a termination of the expansion of Medicaid, the Federal-state health insurance for lower-income individuals, through a simple majority. The ACA required states to provide coverage to those making significantly less than the Federal Poverty Line. Depending on income and number of members in a household, individuals could be eligible to obtain coverage aimed at being affordable.
Koger said repealing the ACA and removing these requirements could lead to problems for many, including hospitals that serve lower-income patients.
“There will be chaos for patients, hospitals, doctors if you take all these people out without a replacement,” he said.
The most recent step by the new administration to repeal the ACA came hours after Trump was inaugurated as the 45th President of the United States. The newly-installed president signed an executive action instructing federal agencies to waive regulations associated the ACA to the fullest extent allowed by the law.
Correction, Feb. 10, 2017: This article originally stated that Donald Trump was the 44th president of the United States, which is incorrect. Trump is the 45th president.