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Repeal of Affordable Care Act Could Cause "Chaos"

Serious problems are predicted if Congress repeals the Affordable Care Act without a replacement plan. (WHOI/Wiki)
Serious problems are predicted if Congress repeals the Affordable Care Act without a replacement plan. (WHOI/Wiki)
January 13, 2017

CONCORD, N.H. - Repeal of the Affordable Care Act without an immediate replacement throws the U.S. health-care system into turmoil over the next three years, according to some economists.

The Urban Institute has projected that the most likely plan for repeal would leave nearly 30 million uninsured by 2019, send insurance markets into chaos and threaten hospitals.

Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, predicted that insurers will start canceling coverage in the face of billions in losses when there's no longer a mandate to buy insurance. However, Park said the largest impacts may come in two years, when the repeal of Medicaid expansion and the insurance subsidies that help people pay for coverage are likely to kick in.

"More than doubling the number of uninsured that otherwise would occur," he said, "and that would be a higher number than was in place pre-Affordable Care Act, because of the virtual collapse of the individual market that would result."

President-elect Donald Trump said this week he is going to push to repeal and replace the ACA "essentially simultaneously." He and Republicans in Congress have criticized Obamacare for rising premiums and reduced choice of doctors and insurance options. They campaigned on the promise of immediate repeal, even though the program has just finished its largest signup period ever.

Some ACA opponents have said first up for repeal will be the taxes, mostly on high-income households, that pay much of the program's cost. Park said they found more than half of these tax cuts would go to millionaires or richer, according to Congressional Budget Office figures. Without that revenue, he said replacing the ACA would be difficult or could mean taking funds from Medicare or Medicaid. Park said that could explain the delay.

"The most critical aspect is that there is no replacement plan," he said, "that replacement would happen at some subsequent point, assuming there even is a replacement plan."

The Urban Institute has projected that by 2019, health-care providers will have to give four times the amount of uncompensated care they do now. In that year, Park said, they'll also lose $146 billion in revenue because they have fewer patients with insurance, which will be a threat to many hospitals.

"Rural hospitals in states that have seen improvements because of the adoption of the Medicaid expansion in their states - that would all be reversed, and more, under ACA repeal," he said.

More information is online at cbpp.org.

Mike Clifford, Public News Service - NH