Obamacare deadline extended: Could the ACA be entering its final act?

How long will the Affordable Care Act survive after US President-elect Donald Trump takes office?  

First Look

Americans seeking coverage under President Obama's prized health insurance law in time for New Year's Day still have an opportunity to sign up, after high demand prompted federal officials to extend last week's deadline to Monday at 11:59 p.m. Pacific time.

Mr. Obama aims during his final enrollment period in office to see a record number of signups under the Affordable Care Act before his successor has an opportunity to gut the 2010 law, known to critics and proponents alike as "Obamacare." Open enrollment will continue through the end of January, giving customers until 11 days after President-elect Donald Trump's inauguration to sign up or change their 2017 existing plans.

It remains unclear how long the law could survive thereafter, since Mr. Trump and his fellow Republicans, who will enjoy majorities in both houses of Congress, have pledged to scrap the policy and supplant it with their own health care plan – even as they continue hammering out the details.

"We'll repeal it and replace it," Trump said in an interview on CBS's "60 Minutes" in November. "We’re going to do it simultaneously – it'll be just fine," he added, assuring Americans that there would be no gap in their coverage.

Trump said he would even consider saving the law's more popular provisions, including the requirement that children be permitted to remain on their parents' plans until age 26 and the mandate that requires insurance companies to provide coverage regardless of preexisting conditions.

But critics question whether it would be feasible to do away with the law's controversial mandates while retaining its desirable traits. It will be far easier, therefore, to repeal Obamacare than it will be to replace it, as The Christian Science Monitor's Francine Kiefer wrote last month:

That’s why House Republican majority leader Kevin McCarthy of California told reporters ... that the plan is to repeal first, then set a transition period in which the law would still be in effect while lawmakers would hash out a replacement.

The replacement would have to be bipartisan if it is to get past the 60-vote threshold in the Senate that’s now required for most legislation, Rep. McCarthy said. A slew of Democratic senators from red states who face reelection in 2018 may well feel pressure to compromise with the GOP on a replacement.

At the same time, not all Republicans in the Senate may agree with their House colleagues.

Although legislation to dismantle Obamacare could be passed during the first few months of Trump's administration, the effective repeal of Obama's legacy health care law could take as long as four years, an unnamed GOP aide in the US House of Representatives told the Associated Press.

"We're working on an aggressive timetable for 2017," Speaker of the House Paul Ryan (R) of Wisconsin said at a poverty-themed forum event hosted Thursday by the think tank Opportunity America, the Associated Press reports. "We're right now sitting down with Sen. McConnell and the Trump administration, the transition team, to try and flesh out what we think is a realistic timetable so that we get the legislation prepped and ready to go." 

Rep. Tom Price (R) of Georgia – Trump's pick to lead the US Department of Health and Human Services – supports a series of propositions known in the House as "A Better Way." The document calls for keeping Obamacare's popular provisions while dropping federal and state "marketplace exchanges," as the Monitor's Ms. Kiefer reported. The outline calls for the government to help Americans buy insurance on the open market with refundable tax credits.

Additionally, top leaders in the incoming administration have expressed approval for promoting competition among health insurance providers across state lines, and also pre-tax contributions to health savings accounts.

"The Republican approach is designed to focus on the individual, the patient – not on a government program," G. William Hoagland, senior vice president of the Bipartisan Policy Center, told Kiefer. "It’s a very private-sector oriented approach to healthcare."

The deadline to sign up on Healthcare.gov for Jan. 1 coverage is 11:59 p.m. Monday in the Pacific time zone, with the final deadline for 2017 coverage on Jan. 31. The website handles Obamacare sales for the 38 states that do not operate their own exchanges.

The deadline to sign up for Jan. 1 coverage passed Saturday for residents of California, New York, and Connecticut. The deadline for Jan. 1 coverage is Dec. 23 for residents of Massachusetts, Rhode Island, and Washington State.

This report includes material from the Associated Press.