What Can Happen if the Affordable Care Act Is Repealed

It is clear that change is coming to the Affordable Care Act (ACA), nicknamed Obamacare, but that is about the only thing that is clear. Instead of trying to fix the current plan and the parts that are considered to be not working, all indications are that the ACA will be completely repealed and hopefully replaced. The movement to repeal is clear, however, there is no real replacement plan at this time. It appears that in this case the baby will be thrown out with the bathwater. (For related reading see: What if Obamacare is Repealed?)

Where Does the ACA Repeal Stand?

With that said, nothing has actually happened yet that impacts existing insurance plans. A first step towards repealing the Affordable Care Act is underway in the House and Senate and would entail de-funding components of the ACA (the ACA premium tax credit program and the cost-sharing reduction program). Taking away the money would have a significant negative impact, though the full impact is not known. This vote to de-fund the ACA seems to have been delayed for a couple of months. Trump is threatening to repeal and replace it immediately, however, right now his plan is a “secret.”

To repeal the ACA completely would take a majority vote in the Senate, which the Republicans do not have, as some Republicans have voiced concern over people being uninsured. To completely repeal the plan and replace it could and would most likely take years, while the de-funding would only take a few weeks. There is the possibility though that Trump and others who wish to force a full ACA repeal through the Senate could ignore advice of the Senate parliamentarian on whether an ACA-related budget measure is related to the federal budget. Historically, Senate leaders have taken the advice of the parliamentarian about whether measures relate to the budget, however it is not a legal requirement. (For related reading, see: Opinion: Welcome to Trumpcare.)

Repercussions of Repealing the ACA

The repercussions of de-funding the ACA are not certain, though according to a just-released report from the Congressional Budget Office (CBO), the consequences will be significant. The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million and then to 32 million in 2026. Premiums in the non-group market (for individual policies purchased through the marketplace or directly from insurers) would increase by 20% to 25%—relative to projections under current law—in the first new plan year following enactment. The increase would reach about 50% in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.

How Insurers Feel About Repeal

Overall, insurance companies are not in favor of having the ACA repealed as they have adjusted to it and spent significant amounts of money to comply with it. Therefore there is real pressure for there to be a suitable replacement plan that would cover individuals with pre-existing conditions. Republicans are currently proposing a return to the old high-risk plans, which were expensive and limited. (For related reading, see: The Beginning of the End of Obamacare.)

Unfortunately, Trump has shown a tendency to do the unexpected, so this could change. The immediate action that Trump could take is to stop the federal government from defending lawsuits brought against the ACA. The significance of this is unknown. Kaiser Health News compiles the top stories and is a great source of information.

While this may not provide much comfort to those of us who have a member of our family who has a pre-existing condition (which is estimated to be about 26% of all Americans), there is media attention and other scrutiny from advocacy groups being brought to the issue. The ability of those with pre-existing medical conditions to get coverage and for there to be a minimum of mandatory benefits is why the Affordable Care Act was a huge step forward despite having a significant number of issues. It is a great time for all of us to get involved and share our opinions with our legislators. Perhaps reason will prevail and changes can be made that will retain what's good and amend what's problematic.

Please note that these are my opinions and are not intended to be any type of political commentary, even though this is all about politics rather than about health care consumers. (For related reading, see: Healthcare Costs in 2018: The Great Unknown.)