10 things you didn’t realize you’d miss about Obamacare

President-elect Donald Trump on Monday announced Rep. Tom Price as his pick for head of the Department of Health and Human Services. And the Georgia Republican is a longtime critic of the Affordable Care Act.

Price has sponsored legislation to repeal Obamacare and replace it with tax credits for individual and family insurance plans. His ideas also influenced House Speaker Paul Ryan’s “Better Way” agenda for replacing Obama’s signature health law.

Obamacare as America knows it appears to be in trouble.

The Affordable Care Act encompasses much more than the well-known provisions such as individual mandates, premium subsidies, and bans on discrimination based on pre-existing conditions. Trump and Congress seem eager to significantly alter and replace aspects of the law, which would in turn alter many aspects of the nation’s health care system.

For instance, the ACA:

• Placed caps on insurance company profits by generally requiring insurers to spend at least 80 percent of their money on patient care rather than on administrative expenses like executive bonuses and salaries.
• Created rules for charitable hospitals to develop financial aid plans for and limit costs to low-income patients, and required charitable hospitals to assess whether patients qualify for financial aid before sending debt collectors after them.
• Covered domestic violence screening and counseling for all adolescent and adult women, and exempted victims of domestic violence from fees for not buying insurance.
• Established a research institute for comparing the effectiveness of different drugs and treatments.
• Created the Prevention and Public Health Fund to encourage improvement in public and community health. This year, $932 million funded programs to address diabetes, Alzheimer’s, hospital-acquired infections, lead poisoning, and more.
• Provided an easier pathway to FDA approval for “biosimilar” drugs that are close or equivalent in structure to biologic drugs like vaccines, insulin, and human growth hormones that are already FDA-approved.
• Allowed foster children to receive Medicare until they are 26, mirroring the better-known ACA rule that allows kids to stay on their parents’ insurance until that age, which Trump has said he’d like to keep.
• Mandated break time in workplaces for nursing mothers, and required employers with more than 50 employees to give nursing mothers private spaces to pump breast milk.
• Imposed a 10 percent excise tax on tanning bed customers, also known as the “Snooki tax.”
• Required chain restaurants to display calorie counts on menus.

Donald Trump’s transition platform says he’ll ask Congress on day one of his administration to repeal Obamacare. During the Obama administration, Price and his fellow Republicans in Congress passed dozens of bills repealing the ACA, knowing the measures would ultimately be vetoed by Obama.

“That was a political exercise,” said Joe Antos, a Health Care and Retirement Policy scholar at the conservative American Enterprise Institute. “Now it’s serious.”

Whatever replaces Obamacare, it’s unlikely that anyone will lose coverage through at least 2017, Antos said. Before they can gut the law, Congress will need to take stock of all it does — and figure out, piece-by-piece, what to put in its place.

“Republicans and Democrats are politicians,” Antos said. “They care about the next election. Simply repealing everything and not replacing is not in the cards. No politician is going to vote for that.”