Unfortunately, it will not be Republicans lawmakers who will have to do the swallowing, but the American people.
The Congressional Budget Office, which historically has mattered when it came to making decisions that could affect millions of people, has given us insight into what it would mean to repeal the Affordable Care Act.
It is important to note that it scored a partial repeal plan, the one passed in 2015. That left certain provisions in place, like covering pre-existing conditions.
The repeal bill would address two main issues. It would repeal the individual and the employer mandates, and it would eliminate spending on both Medicaid expansion and subsidies to help individuals purchase insurance on the individual market. This destabilizes the insurance market by violating the fundamental principles of insurance. This means that the sicker, more vulnerable people with higher costs would remain insured while the younger healthier people would be uninsured. Premium costs are projected to rise 20 to 25 percent in the first year, while cost for insurers would increase enough to drive most from the market.
The CBO further estimates that the deficit would increase by $137 billion in 10 years, but would increase by growing amounts after 2025. The tax effects are an area that Republicans will have to contend with. If Congress decides to immediately repeal all Obamacare taxes, the richest 1 percent would save on average $33,000, while those earning less than $89,000 would have a tax increase. Of those earning less than $25,000, 7 percent would have an average rise of $3,900 in taxes. Those earning $25,00 to $89,000 would see and average increase of $6,200.
In Utah, 175,637 people were insured through the marketplace (ACA) in 2016. Eighty-seven percent of those Utah citizens received premium subsidies. From 2010 to 2015 Utah’s uninsured rate decreased 40 percent to 10.5 percent. Despite this improvement, because Utah did not expand Medicaid, 70,000 Utahns were without access to affordable health care.
Given these thorny issues, Republicans are becoming aware of the challenge facing them. However, Sen. Orrin Hatch’s response in The New York Times indicated perhaps a pervasive miscalculation of what it will take to overcome these projections. He said, “Today’s report shows only part of the equation — a repeal of Obamacare without any transitional policies or reforms to address costs and empower patients. Republicans support repealing Obamacare and implementing step-by-step reforms so that Americans have access to affordable health care.” Rep. Kevin Brady, chair of the House Ways and Means Committee, said that the GOP’s replacement efforts would “establish a robust health care marketplace based on innovation, competition, and choice.”
These statements hint at shifting the costs onto people who have no ability to absorb them. To speak of empowering and providing choice to economically disadvantaged citizens, half of whom will live in areas where there are no insurers in the individual market, seems devoid of common sense. To shift the problem back to the states because it is too hard politically to find a viable option would be putting us back to where we were for 50 years.
As citizens with a lot at stake, we will have to insist on rigorous analysis of the various options that are being proposed. We will have to take the CBO seriously. We will have to insist that our economy, our health, and our futures not be destabilized to satisfy a stale, bitter, political promise to repeal Obamacare.
Julie Day, M.D., is Quality Medical Director for the University of Utah Community Physician Group. Her opinions are her own and do not necessarily represent her employer.