Summary of CBO Analysis of HR 1628 at https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52939-hr1628amendment.pdf
President Trump and Republican Senate Majority Leader Mitch McConnell have abandoned “repeal and replace” Obamacare (the Affordable Care Act) and instead embraced a straight-out repeal of Obamacare as requested by President Trump, the House Freedom Caucus and Senators Cruz, Lee and Paul. Their calculation is that this threat will cause Democrats to join forces with them on a "repeal and replace" alternative. One might ask “what are they smoking?” “Why this crusade against coverage for low, moderate and middle income Americans, why this crusade to deny coverage for sick people?”
The Congressional Budget Office projects that, as compared to current law (ObamaCare), this proposed repeal would increase the numbers of uninsured by 32 million, increase premiums by 100% in the individual markets and cause insurers to leave the individual market, such that 3/4th of nation’s population would have no insurer participating in the individual market.
Repealing Obamacare would reduce the federal deficit by $473 billion over 10 years. It would decrease Medicaid spending by $842 billion by repealing Medicaid expansion under the ACA. It would eliminate tax credits through Exchanges in the individual market -- $454 billion. It would reduce taxes by $613 billion, primarily on unearned income from high-income individuals, and it would reduce penalty payments by $210 billion, primarily from large employers who do not offer health coverage for their employees.
The huge increase in individual market premiums and the exit of individual insurers would be caused by the loss of healthy young lives in the individual market that were attracted to enroll by the tax credits, the market reforms and individual responsibility (individual mandate) in the ACA. In other words, the ACA’s tax credits for premiums and cost sharing, the market reforms, plus the individual mandate increased participation in the individual market quite substantially and balanced those with pre-existing conditions who were also allowed to enroll under the ACA. Taking away the tax credits and individual responsibility would produce what is referred to by health insurers who are adamantly opposed to "repeal" and to the Cruz amendment as "a death spiral" because only the unhealthy and very wealthy would keep paying their premiums in the individual market and the low and moderate income and healthy individuals would drop their coverage.
The calculations of the Senate Republican leadership and President Trump are two fold. First they fear their base of 25% of hard care repeal supporters would abandon them in the next election unless they follow through on their campaign promises to repeal Obamacare as would their big money donors led by the Koch Brothers. Second, they believe the Democrats to avoid the devastating impacts of “repeal” on the country’s health system would help the Republicans get Trumpcare (repeal and replace) across the finish line so that only 22 million would lose their coverage instead of 32 million under a straight repeal. This is a mighty risky bet and a far cry from then Candidate Trump's promises of coverage for all, lower premiums and lower copays and deductibles.
Since the collapse of repeal and replace, Democrats have offered to participate in a bipartisan effort with Republicans to improve (not repeal) the ACA. They are not ready to retreat on the ACA's coverage expansions and assistance to low, moderate and middle income Americans in the individual market, which seems to be the obsession and preoccupation of the now dominant right wing of the Republican party. Can common sense prevail or are most Republicans locked into seven years of campaign rhetoric? You can help by contacting your Senators and Representatives.
Prepared by: Lucien Wulsin