If the GOP Actually Repealed Obamacare, Here's What Would Happen
Utter chaos is an understatement.
sdecoret/Shutterstock
On
Tuesday, the Republican-controlled House of Representatives plans to
vote once again to repeal the Affordable Care Act. It will be the 55th time
House GOPers have voted to eliminate or impede the health care reform
law, but the very first opportunity for freshman Republicans to register
their opposition to Obamacare in the congressional record.
But
with each repeal vote, the politics of rolling back the Affordable Care
Act become more fraught. After all, the law is now enmeshed with the US
health care system. "Talk of repealing the Affordable Care Act is like
talk of repealing the interstate highway system," says Timothy Jost, a
health care law expert at the Washington and Lee University School of
Law. "I mean in theory you could do it. Nobody would want to live with
it."
Since
President Barack Obama will never sign legislation repealing his
signature accomplishment, a vote to strike down the law is largely
symbolic. But what if, in some parallel universe perhaps, repeal passed?
"If
you with a stroke of a pen took the Affordable Care Act away and there
was no transition period, there would essentially be havoc in the
markets," says Linda Blumburg, a health care policy analyst. It's a
hypothetical not too far from reality since the Supreme Court could gut
the law in a decision this summer—an outcome that Republicans strongly
support, even while they lack a legislative response to what would be a
disastrous scenario for millions of their constituents.
"Basically, you would have a lot of people die because they couldn't get health care."
In anticipation of the case, King v. Burwell,
health care experts have been crunching the numbers to figure out what
would happen if the Supreme Court dismantles Obamacare in states that
rely on the federal government to run their healthcare marketplaces.
Though the Supreme Court scenario, which would halt the subsidies to
people purchasing insurance in the federally-run marketplaces, is not
the same as full repeal, it helps paint the picture of what would
happen. And the picture is not pretty.
If the Supreme Court stopped subsidies from flowing to the 34 states that did not establish their own exchanges, 8.2 million fewer people would have coverage by 2016, according to research released this month by
the Urban Institute, an economic and policy research outfit. Next year,
the number of people insured through purchasing private plans would
drop by 69 percent.
Without
subsidies to purchase insurance, many people would immediately lose
coverage because they could no longer afford it. Others could be kicked
off their plans without Obamacare's protections for people with
pre-existing conditions. "You would just have an awful lot of people be
uninsured, and then that ripples back through the health care system,"
Jost says. "Basically, you would have a lot of people die because they
couldn't get health care."
This
is just the tip of the iceberg. A roll back of the Medicaid expansion
would cause millions more Americans to lose their coverage and create
mayhem for state governments. Without the ACA to plug the so-called
"donut-hole" for prescription drugs, seniors would see their drug bills
go up.
A
Supreme Court decision against Obamacare would cost millions of
Americans their coverage, but full repeal by Congress would be even more
devastating. Health care experts describe a state of complete chaos
were the ACA to simply disappear from the books.
By
now, the ACA has so fundamentally changed the health care system that
repeal would not simply return the country to its pre-Obamacare state.
The Urban Institute estimates that just rolling back subsidies for
people in states with federally-run exchanges—the Supreme Court
scenario—would create such turmoil in the private insurance market that
the number of people in 2016 buying private plans on their own would be
substantially lower (just over 1 million) than if the ACA had never been
implemented (about 7.3 million). In other words, destroying the
exchanges would be much worse than if they were never implemented at
all. Returning to the way things were is no longer possible.
Repeal
would be bad for insurers as well as customers by causing at least
short-term turmoil for insurance companies. Without an individual
mandate and without subsidies to make insurance affordable, younger,
healthier people would likely drop their coverage, leaving insurers to
cover older, sicker people with more health-care needs. But insurance
companies can't raise premiums until next year because the 2015 rates
have already been locked in—at the very least, it would take months to
renegotiate rates with each state. The result, according to Blumberg, a
co-author of the Urban Institute report, could be that companies spend
more on coverage than they bring in on premiums. Not exactly a problem
these companies are looking forward to.
Republicans
are starting to realize that—even for a symbolic vote of protest
against Obamacare—the reality is that repeal alone is not an option.
On Friday, House Majority Leader Kevin McCarthy (R-Calif.) announced the
formation of a working group to come up with an Obamacare alternative
and a contingency plan in the event that the Supreme Court guts the law.
And for the first time, the bill the
House plans to vote on this week requires that the relevant House
committees draft replacement legislation for the law. And, though not
currently in the text of the bill, its sponsor, Rep. Bradley Byrne
(R-Ala.), plans to introduce an amendment to the bill that would delay
repeal for 180 days to give Republicans time to craft a replacement,
according to a Byrne aide.
No comments:
Post a Comment