Impacts of Repealing the ACA as Recently Approved by the House and Senate According to the Congressional Budget Office
The Congressional Budget Office today released its analysis of the selective repeal of the Affordable Care Act as recently approved by Republicans in the House and Senate. Premiums in the individual market would initially spike by 20-25% and eventually would double due to repeal. The numbers of the uninsured would grow by 18 million in year 1, then increasing to 27 million and eventually grow to 32 million.
The repeal is selective in that budget reconciliation can only repeal the budgetary aspects of the ACA such as the Medicaid expansion, the refundable tax credits under the Exchanges (like Covered California) and the tax penalties for not buying insurance (the individual mandate). It cannot repeal other ACA protections such as the immensely popular ban on pre-existing condition exclusions.
Premiums in the individual market would spike because without the refundable tax credits to assure affordability and the tax penalties, increasingly the older and sicker would continue to purchase coverage and the rest of the healthier population increasingly becomes uninsured.
The huge growth in the numbers of uninsured Americans are due to three overlapping factors that are being implemented at different times under the repeal legislation: 1) the loss of the tax penalty incentives for individuals and employers (the mandates), 2) the loss of the refundable tax credits (premium assistance) for individuals and families under 400% of FPL and for low wage small employers in the Exchanges (Covered California), and 3) the repeal of the Medicaid expansion.
The House and Senate Republican leaders say “not to worry” we have replacement legislation that will avoid all these problems. In fact they have no replacement legislation, but they are working on beginning to talk about it among themselves; there is nothing remotely ready to be shared with the public. It will take 60 votes in the Senate to pass replacement legislation and Republicans only have 52.
President Trump says I’m going to cover everyone, reduce high deductible plans, make coverage more affordable and negotiate down the high prices of pharmaceuticals. “Nice work, if you can get it”, but his spokespersons immediately began walking back Trump’s promises.
“So what should I do”? First, make sure you enroll in Covered California before January 31, 2017. That is the last day for open enrollment and your premiums are guaranteed for the next year; you should shop first based on price as some plans jacked up their premiums significantly while others did not. Just make sure your doctor is in the plan you ultimately select or be prepared to choose a different doctor. There is no deadline for Medicaid (Medi-Cal), but why run the risk that Congress will change it while you are not looking.
Write and keep on writing your Congressperson and Senator, have your friends and family, your doctor, pharmacist and insurance brokers write too telling your elected representative what type of reform you want. It’s your health and there are 15 million Californians in the same bind. It is slowly beginning to dawn on some what a perilous, and uncharted journey they have initiated and the health and then political consequences if they mis-step; those numbers are steadily growing (8-10) in the Senate and increasing numbers in the House as well.
According to the latest Wall Street Journal poll over half of Americans now think the ACA was a good idea and only a quarter of Americans have strong confidence that Republicans have a better idea to replace it. However a high percentage of Republican voters want to see it replaced and a similarly high percent of Democrats want to see it retained. This is a high stakes moment for the President-elect and Republican majorities in both Houses. Repealing the ACA will have huge consequences on coverage, not just in California, but throughout the Rust Belt where Medicaid expansion has proven exceptional and high percentages of state residents depend on the ACA.
Prepared: Lucien Wulsin