The repeal of Obamacare has grown increasingly complicated for the GOP Congress and the incoming Trump administration. This week, the Congressional Budget Office released its assessment of the impacts of the current Republican effort to repeal the Affordable Care Act, and its conclusions are dire. In the first year of repeal, the nonpartisan CBO concludes that 18 million Americans would lose their health insurance, and that number would rise steadily over the next several years.
For most, it would simply come down to lack of affordability. The Republican repeal measure, after all, would eliminate funding for the expansion of Medicaid and for the payment of premium subsidies that currently help make individual insurance plans affordable for most Americans on the ACA exchanges.
It is true that the individual marketplaces set up under the ACA saw sizable premium increases this year, but for most Americans buying insurance through an exchange, simultaneous increases in their premium subsidies meant their out-of-pocket expenses remained largely the same. That’s how the ACA was designed to work.
By repealing those premium subsidies, as the Republicans in Congress hope to do in the next few weeks, health insurance would become unaffordable for millions of Americans, and hundreds of thousands of Minnesotans. Inevitably, the healthiest Americans would be the first to drop their coverage, leaving only the sickest remaining in the individual market. And that’s one of the reasons that the CBO also predicts that the repeal plan would raise health insurance premiums by another 20-25 percent in the first year alone, with much higher premiums after that.
Republican leaders note that the CBO only looked at the effect of repeal, not whatever replacement plan the GOP ultimately implements. But there’s little evidence that the Republicans have a viable plan at this point, and Donald Trump appears increasingly out-of-step with GOP leaders in Congress. This past weekend, Trump told the Washington Post that the plan he expects to put forward will include universal coverage, lower premiums, and lower deductibles. All of which sounds a lot like the Medicare-for-all plan being pushed by Bernie Sanders and progressive Democrats. Yet Republicans in Congress have no intention of adopting a replacement plan that achieves any of the laudable goals outlined by Trump, or Sanders.
The fact is, short of adopting a single-payer system or providing substantial premium subsidies for Americans to purchase insurance on the private market, there is no way to make quality health insurance more affordable given the high cost of health care in the U.S.
GOP leaders have recently been touting the use of ultra-high deductible plans, combined with health care savings accounts, but that’s only a viable option for the well-to-do. The Americans who need help won’t get it from an insurance plan that forces them to pay anywhere from five- to twenty-thousand dollars out of pocket before their insurance kicks in. To think that most lower and middle-income Americans will be able to fund health care savings accounts to cover such annual deductibles is pure fantasy. Every health care analyst who has looked at this GOP proposal has concluded that it’s a boon only for the wealthy.
Meanwhile, all the media attention that the GOP repeal effort has placed upon the ACA has pushed the law’s approval rating to the highest level since its passage. And half of Americans say they have little to no confidence that the GOP will develop a satisfactory replacement plan. Skepticism is highly justified.
The problem for Republicans is pretty basic— the ACA was based on conservative GOP principles, so it’s difficult for Republicans to find a replacement that marks a significant change, while still finding support from Republican lawmakers. Simply gutting the subsidies and the Medicaid expansion in the ACA, which is the only piece of the plan that the GOP seems to agree upon, will throw tens of millions of Americans off their health insurance and would almost certainly spark major political blowback at the polls come 2018.
As Republicans are quickly finding out, it’s easy to stand in the way of governing. It’s a lot tougher when you’re handed the reins.