Before the January 20th inauguration, the senate voted on a budget that would allow the repeal of the Affordable Care Act. On January 20th as president, Trump’s first executive order instructed federal agencies to ease the burdens associated with the Affordable Care Act. Neither action actually repealed the ACA, but both alarmed the public with concerns ranging from what it means for the the opioid epidemic to the possibility of industry-wide insurance market destabilization, job losses, and revenue losses for both federal and state governments.
Later this week, the House Energy and Commerce Committee will hold a “Patient Relief from Collapsing Health Markets” hearing to review four bills that attempt to mitigate impacts of a possible repeal of the Affordable Care Act, making this week the time to start paying very close attention to how the new administration will overhaul the U.S. healthcare system.
What Would a Full ACA Repeal Do?
The impacts of a full ACA repeal without new legislation, in brief, include:
- Ending subsidies for the marketplace exchanges, effectively raising the cost of insurance outside the reach of lower and middle income citizens
- Ending federal funding in the 31 states that expanded Medicaid to very low income citizens
- Eliminating the individual mandate, which is key to stabilizing the overall premium rates by broadening the risk pool in the exchanges, and
- Reducing core benefits and protections that the ACA guaranteed, including requiring insurers to eliminate restrictions based on preexisting conditions, to cover preventive care, and to cover dependents up to age 26.
Hurdles the GOP Faces on Repeal and Replace
As the GOP attempts to repeal the ACA through the budget reconciliation process and at the same time mitigating the impacts of a sudden repeal, House Republicans are considering multiple bills that address these concerns in different ways. However, passing them requires a unified Republican position and the support of some Democrats. With half of states that expanded Medicaid under the ACA governed by Republicans, garnering full Republican solidarity to stop funding of Medicaid expansion is uncertain, for a start.
Health Affairs reports that two themes have been proposed by Republicans over the years of their anti-ACA battle: (1) “universal access” and (2) delegation to the states. Guaranteeing universal access means everyone will continue to be eligible for insurance, but the price will not be regulated by subsidies that were justified under the ACA’s universal coverage. Delegation to the states means states would have more control over their Medicaid plans by having access to block grants and would potentially be able to continue their own version of the ACA without federal involvement.
Whatever the new proposed legislation looks like, at the very least the marketplace options and prices will change drastically in 2018 since payers will likely be exiting in droves. At the most, it will be a seismic shift felt across the industry and the economy, not unlike the one created by the ACA just 7 short years ago.
