‘Oba­macare’ re­peal-only would make 30m unin­sured

‘Re­place’ stalls

Kuwait Times - - HEALTH & SCIENCE -

WASH­ING­TON: Re­peal­ing Pres­i­dent Barack Obama’s health care law with­out a clear re­place­ment risks mak­ing nearly 30 mil­lion peo­ple unin­sured, ac­cord­ing to a study re­leased yes­ter­day. Repub­li­cans say that won’t hap­pen be­cause they are work­ing on re­place­ment leg­is­la­tion for a Pres­i­dent Don­ald Trump to sign. Nonethe­less, the com­plex two-stage strat­egy the GOP Congress is con­tem­plat­ing has raised con­cerns.

The plan is for Congress to first use a spe­cial bud­get-re­lated pro­ce­dure to re­peal ma­jor por­tions of the Af­ford­able Care Act, or ACA, next year. The ef­fec­tive date of that re­peal would be de­layed by months or years to give law­mak­ers time to write re­place­ment leg­is­la­tion.

The re­place­ment law would pre­sum­ably do many of the same things that “Oba­macare” does, such as sub­si­diz­ing cov­er­age and pro­tect­ing peo­ple with health prob­lems. But it would not in­volve as much fed­eral reg­u­la­tion, and it would elim­i­nate a highly un­pop­u­lar re­quire­ment that most Amer­i­cans get health in­sur­ance or face fines.

‘Re­place’ stalls

Yes­ter­day’s anal­y­sis from the non­par­ti­san Ur­ban In­sti­tute looks at a sce­nario where “re­peal” goes through, but “re­place” stalls. It pre­dicts heavy col­lat­eral dam­age for peo­ple buy­ing in­di­vid­ual health in­sur­ance poli­cies in­de­pen­dent of gov­ern­ment mar­kets like Health­Care.gov. Though non­par­ti­san, the Ur­ban In­sti­tute gen­er­ally sup­ports the goal of ex­tend­ing cov­er­age to all Amer­i­cans. Pre­vi­ously it has crit­i­cized some of the sub­si­dies pro­vided un­der Obama’s law as in­suf­fi­cient.

The new anal­y­sis warns that re­peal­ing ma­jor parts of the health law with­out a clear re­place­ment could up­end the health in­sur­ance mar­ket for peo­ple buy­ing their cov­er­age di­rectly, out­side of the work­place. That group has grown sub­stan­tially un­der the health care law, but also in­cludes mil­lions of other cus­tomers.

The study found that 22.5 mil­lion peo­ple would lose cov­er­age di­rectly due to re­peal of the law’s sub­si­dies, Med­i­caid ex­pan­sion, and its in­di­vid­ual re­quire­ment to carry health in­sur­ance.

An­other 7.3 mil­lion would be­come unin­sured be­cause of the rip­ple ef­fects of mar­ket up­heavals. That could hap­pen if in­sur­ers lose con­fi­dence in the Repub­li­can prom­ise of a re­place­ment and aban­don the in­di­vid­ual mar­ket. A key in­dus­try worry is that a re­peal law would get rid of sub­si­dies and man­dates but still leave in­sur­ers on the hook for cover­ing peo­ple with health prob­lems.

The num­ber of unin­sured peo­ple would rise to nearly 59 mil­lion in 2019, and the na­tion would have a higher unin­sured rate than when the ACA passed in 2010, the study found. Fed­eral and state govern­ments would save tens of bil­lions of dol­lars, but the po­ten­tial price would be so­cial dis­lo­ca­tion and a po­lit­i­cal back­lash. “This sce­nario does not just move the coun­try back to the sit­u­a­tion be­fore the ACA,” the study con­cluded. “It moves the coun­try to a sit­u­a­tion with higher unin­sur­ance rates than was the case be­fore the ACA’s re­forms.

“To re­place the ACA...with new poli­cies de­signed to in­crease in­sur­ance cov­er­age, the fed­eral gov­ern­ment would have to raise new taxes, sub­stan­tially cut spend­ing, or in­crease the deficit,” the au­thors added. That’s be­cause the taxes used to fi­nance Obama’s cov­er­age ex­pan­sion would also be re­pealed. Repub­li­cans say they won’t al­low chaos to hap­pen. “We are not go­ing to rip health care out of the hands of Amer­i­cans,” House Ways and Means Chair­man Kevin Brady, R-Texas, said in a re­cent in­ter­view with As­so­ci­ated Press re­porters and edi­tors. “Repub­li­cans are go­ing to give Amer­i­cans choices and an ap­pro­pri­ate transition.”

— AP

WASH­ING­TON: In this Oct 24, 2016, file photo, the Health­Care.gov 2017 web site home page.

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