Study: A re­peal of ACA will leave 3M unin­sured

Repub­li­cans dis­miss pos­si­ble risks, pro­mote re­place­ment leg­is­la­tion

The Denver Post - - NATION & WORLD - By Ri­cardo Alonso-Zal­divar

wash­ing­ton» Re­peal­ing Pres­i­dent Barack Obama’s health care law with­out a re­place­ment risks mak­ing nearly 30 mil­lion peo­ple unin­sured, ac­cord­ing to a study re­leased Wed­nes­day.

Sep­a­rately, a pro­fes­sional group rep­re­sent­ing ben­e­fit ad­vis­ers warned con­gres­sional lead­ers of the risk of “sig­nif­i­cant mar­ket dis­rup­tion” that could cause mil­lions of Amer­i­cans to lose their health in­sur­ance.

Repub­li­cans dis­miss such dire sce­nar­ios, say­ing that 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 not only among sup­port­ers of the law, but also in­dus­tries like hospi­tals and in­sur­ers.

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 even 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.

The new study 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 con­cerns raised by the Ur­ban In­sti­tute study were un­der­scored Wed­nes­day in a let­ter to con­gres­sional lead­ers from the Amer­i­can Academy of Ac­tu­ar­ies. The group rep­re­sents pro­fes­sion­als who ad­vise cor­po­ra­tions and govern­ment on how to de­sign and main­tain ben­e­fit pro­grams like pen­sion and health care plans.

The ac­tu­ar­ies said even if Congress de­lays the date of re­peal, the un­cer­tainty could prompt in­sur­ers to stop of­fer­ing in­di­vid­ual plans for peo­ple not cov­ered by em­ploy­ers.

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