WASHINGTON — A Republican-dominated White House, Senate, and House of Representatives are trying to repeal the Affordable Care Act (ACA), former President Barack Obama’s ambitious health care overhaul.
They’ve run into some problems, however.
Soon after taking office, President Donald Trump signed an executive order to start rolling back the ACA, saying he wanted the job done quickly. On Monday, House Republicans introduced their bill to repeal and replace Obamacare under heavy opposition. Beyond the Democrats fighting against the ACA repeal, multiple Republican senators rebelled against the bill.
Other Republicans haven’t backed off — including House Speaker Paul Ryan (R-Wis.), who promised to make a repeal happen within the year.
An Obamacare repeal would have significant ramifications. By one estimate, a repeal could kill more people per year than gun homicides. By another, it would eliminate countless jobs.
Its effects will seep into almost every aspect of American life, including sports.
“If I had a child, and I was not fully insured, that child would not be playing any sport at all because I’d be way too worried about injury,” Rep. Jan Schakowsky (D-Ill.) told SB Nation. “And once that injury is there, if they were to repeal the ACA, that would be a pre-existing condition. That could affect that child for the rest of their life if they couldn’t get the care they needed.”
The effects of a repeal would be felt at all levels of sports, from youth leagues to the NFL. Meanwhile, Congress has to find time to address other health concerns facing committees with sports jurisdictions. A record number of people have enrolled in Obamacare health plans for 2017 despite the administration’s threats. Those plans, as it turns out, are helping to sustain some of America’s biggest pastimes.
Repeal could hurt retired professional players
NFL players make millions, so it may be surprising to know many rely on the ACA for health insurance.
DeMaurice Smith, executive director of the National Football League Players’ Association (NFLPA), explained on CBS’ Face of The Nation last month that the “100 percent injury rate” in football means that all players have pre-existing conditions — health issues that began before their post-retirement insurance policies took effect.
When players leave the NFL, they take with them lingering ailments from the game that can make buying health insurance costly. Before Obamacare, insurers could charge people more or deny them coverage altogether based on pre-existing conditions. The Affordable Care Act banned those practices, making it much easier for former players to get coverage.
The NFL doesn’t offer a comprehensive health benefits program for all former or retired players. Those programs can also be hard to find, hard to access, and hard to qualify for. In 2015, a series by Vice Sports exposed the difficulty of navigating the piecemeal services available to retired players.
The NFL’s 2011 collective bargaining agreement set aside more than $50 million for retired player initiatives, and $22 million specifically for “healthcare or other benefits, funds, or programs for retired players.” Many players may not know they exist, however. Without outside help, many players struggle to take full advantage.
“Your agent kinda helps a little bit, maybe some older players. You start asking questions,” former Broncos and 49ers tight end Nate Jackson told Vice Sports. “[The NFLPA] may have said something to us here or there when we played, but really no one understands what’s waiting and understands what our options are and what the process is going to be like.”
The other issue is eligibility. According to the NFL’s players’ benefits resource document, a player is only considered “vested” and eligible for the league’s retirement plan after three credited seasons. A credited season, as described by the 2011 CBA, is a “full pay status for a total of three or more regular season games.”
Players can only take advantage of league health insurance by hitting that mark, but the average career length of an NFL player is just 2.66 years, according to the Wall Street Journal. That means that the vast majority of NFL players aren’t eligible for league retirement benefits. Players who are eligible get health insurance for 60 months after they are released or severed, at which point they can elect to pay for extended benefits through the NFL, or turn to the union for help.
Nolan Harrison, the senior director of former player services at the NFLPA, told SB Nation that a repeal “is a big fear of ours.” Harrison’s job is to be a resource to former players. The NFLPA began signing up players for Obamacare in 2014 when it partnered with Working America Healthcare, a network that pairs consumers with health insurance.
Before the 2011 CBA, there were generations of former players who weren’t insured, Harrison said. Obamacare, in conjunction with the (albeit cumbersome) benefits framework laid out by the CBA, gave players assistance that they previously didn’t have. According to Harrison, the NFLPA has helped “dozens” of former players sign up for Obamacare.
Many players could be turned away by private insurers prior to the 2011 CBA and the ACA. Some of them went without health insurance because it made them financially unstable.
Former Bengals linebacker Reggie Williams is one example. According to a story in the Washington Post, the former NFL Man of the Year spent hundreds of thousands of out of pocket dollars on medical expenses because he was uninsured. The NFL’s former Man of The Year had gone through 24 knee operations, and a bone infection by 2013, after playing in the NFL 1976-89. He was unable to qualify for most of the NFL’s disability benefits.
The ACA created a safety net for players who couldn’t get help through NFL programs according to Harrison, who played 10 years in the NFL. He called the ACA, “a godsend for us.”
George Atallah, the assistant executive director of external affairs for the NFLPA, said there was a “sense of relief” for players in 2014 because they finally had coverage. Until something changes in Congress, Atallah said the player’s union and others are in “wait and see mode.”
“If they repeal it, it’s going to put a bunch of players in a situation where they don’t have coverage.” Atallah told SB Nation, adding that the NFLPA has helped a “few hundred players” get insured. “If the ACA gets repealed for any reason, we hope to provide them with some guidance for what to do.”
If the ACA is repealed, Harrison says many retired players will go uninsured. The Republican replacement bill would also ban discrimination based on pre-existing conditions, but insurers could charge more to people who have been uninsured in the past for more than two months. That provision could hit uninsured football players especially hard.
Without a proper replacement program, their pre-existing conditions could make insurance costs unbearable.
“Guys were going bankrupt because they weren’t covered,” Harrison said. “The ACA really saved a lot of our guys’ lives.”
Photo by Brendan Smialowski/Getty Images
Repeal would create uncertainty about the risks youth athletes face
In February, Democratic lawmakers and activists detailed to SB Nation their worries that children, among them millions of youth athletes, wouldn’t get the proper preventative and rehabilitative care they need if the ACA is repealed.
Monday’s bill put forth by Republicans seemed to address some of those concerns. Under the bill, the 10 essential health provisions outlined by the ACA — things like rehabilitative services, preventative care, and hospitalization — would stay, as would an option that would allow children to stay on their parents’ healthcare plan until they’re 26 years old.
There are caveats, however.
An aide for the Energy and Commerce Committee, which wrote parts of the bill, clarified that, in the Republican bill, those provisions are “eliminated” for people on Medicaid, the federal health insurance plan that covers kids, pregnant women, some parents of low-income children, people with disabilities, and the elderly. As of November 2016, nearly 69 million people were enrolled.
There are also trickle down effects to consider if healthcare gets more expensive and harder for parents to obtain.
After Obamacare passed, millions more adults were insured, as well as the children they added to their insurance plans. A repeal could cost six to 10 million people health insurance coverage if the Republican bill passes and replaces the ACA, according to Standard & Poor’s preliminary analysis.
Gerard McClean’s company runs Tourney Central, a youth soccer tournament management system based in Ohio. In January, he sent a letter to Congress and major soccer organizations outlining the need to keep the ACA.
“The ACA is not a perfect law, but anything less than the protections and access it currently affords the youth population and their parents is untenable,” McClean wrote. McClean also begged Congress not strip his kids and their community of their “purpose.”
“Don’t rob them of their ability to participate by limiting access to health insurance and health care,” the letter read.
Frank Pallone (D-N.J.) spent chunks of last year calling for “meaningful” action about concussion risks and safety in youth sports. If the ACA is repealed or replaced improperly, Pallone suggested, then any child who gets hurt playing a sport might not get proper treatment.
“If they’re playing football and they get an injury, they can go to the emergency room,” Pallone said. “But if you don’t have a doctor or someone you can see on a regular basis, you aren’t going to get better.”
Republicans didn’t estimate how many people would gain or lose insurance under their plan. The bill keeps some ACA provisions that will protect youth athletes, but it also won’t have a proper estimate from the Congressional Budget Office — a nonpartisan arm of the federal government that produces independent analyses of economic and budgetary issues — of how much it will cost before voting is planned to begin.
Health activists that spoke to SB Nation say they know parents who have been turned away by insurance companies because of their kids’ pre-existing conditions — like asthma, cancer, or diabetes. For years it wasn’t uncommon practice for insurers to do so, but under Obamacare, insurers can’t deny coverage or increase premiums for these conditions.
How the repeal could affect children has charged an already-heated debate. One of the nation’s most prominent children’s health advocates laid out dire stakes. Marian Wright Edelman, 77, has devoted her life to being a children’s rights advocate. She founded the Children’s Defense Fund in 1973, a nonprofit that has fought to give children equal rights by improving federal policy, especially in healthcare — work that earned her the Presidential Medal of Freedom.
She insisted that for children’s sake, “we will hold on.”
“Children will die, needlessly [if the ACA is repealed]” Edelman said. “Children will be injured and not get the healthcare they need and will be crippled if they don’t end up getting their broken legs and limbs taken care of.”
“They can’t do this,” she added. “This can’t go backwards.”
Until ACA is resolved, discussions about other sports issues may be drowned out in Congress
The conversation around the ACA has become so big and loud that it could overshadow other important issues. Congress’ Energy and Commerce committee, one of the committees responsible for overseeing health care legislation, also has jurisdiction over sports issues like CTE, daily fantasy sports, concussions and other items pertaining to youth and professional sports.
“GOP efforts to repeal the ACA will likely suck all of the oxygen out of the room and distract from other critical health issues before the committee, like further investigation into CTE,” a staffer for one of the committee’s members said.
According to Harrison, some players can’t afford to wait.
“Without having something to deal with concussions or CTE, what does that do to guys in treatment or their families dealing with these issues?” Harrison said.
During February, the majority of the committee held hearings about dismantling Obamacare and “laid the groundwork” for moving beyond the package. These discussions were based on a Republican promise that “patients deserve better,” as Rep. Greg Walden (R-Ore.), the Chairman of Energy and Commerce, said in a statement. Republican thinking has been that even if people are enrolled in Obamacare, that doesn’t mean it works.
Schakowsky isn’t worried that the fight over ACA will bog down the committee. She insisted that any discussion about brain injuries in youth athletes is “a very popular conversation to have.”
Pallone echoed her.
“I really think on the concussions issue there’s a lot of bipartisan concern,” Pallone said. “There’s a bipartisan effort to keep pushing the leagues so that we deal with this. We’ve got a long way to go. But I don’t see it as (one-sided).”
Atallah said the NFLPA has communicated to a number of congressional committees to address issues of concern and doesn’t know if the ACA and its attempted repeal will postpone other hearings on sports.
Harrison is less reassured.
“It could be catastrophic to some of our families,” he said. “And if they’re not going to talk about it at the congressional level, if that goes away, we are back at square one.”
Sports are just one of the many realms of American life that could be endangered if the ACA is repealed. From pro players to youth sports leagues, there’s a common fear about the consequences of such an overhaul. Hopefully, Schakowsky said, America is becoming more enlightened about the future of its health.
“People are waking up to the fact that if this law gets repealed, without, at least, as good or better a replacement — which we’ve never seen in all the years — their lives are going to be significantly less secure and their healthcare is going to be in real danger,” she said.
“That applies across the board, from athletes to everyone.”
