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By Alex Ruoff
Nov. 16 — Repealing the Affordable Care Act without an immediate replacement would cause a “massive disruption” of the individual health insurance market, liberal groups said Nov. 16.
Repealing central tenets of the ACA, such as subsidies for those purchasing individual health insurance plans and the requirement that all Americans have health insurance, without replacing them would accelerate the so-called death spiral for the individual market. Healthy people wouldn’t enroll in plans, raising costs for those who need coverage until it would become unaffordable, Topher Spiro, vice president of health policy at the Center for American Progress (CAP), told reporters.
“No insurers want to be left holding the bag,” he said.
Spiro said his group plans to make sure Republicans are blamed for coverage disruptions and rising costs associated with changes to the ACA. CAP and other supporters of the health-care law, such as Families USA, are building a coalition of Democratic lawmakers and think tanks to oppose repeal.
Health policy analysts estimate that more than 20 million Americans gained health insurance over the past six years under the ACA. The nation’s uninsured rate in 2016 reached a historic low, dropping below 9 percent, according to a report by the Centers for Disease Control and Prevention.
Republican lawmakers leading the charge on ACA repeal and President-elect Donald Trump have repeatedly said they’ll ensure that rolling back the law won’t result in Americans losing their health-care coverage or a collapse of the individual market.
Rep. John Shimkus (R-Ill.) countered that many of the people who gained coverage under the ACA don’t want to keep the plans they signed up for because the premiums and deductibles are too expensive.
“People have crappy insurance now,” he told reporters Nov. 15. “They have high costs, high deductibles; it’s like they don’t have insurance.”
House Republicans have indicated they’ll likely use the budget reconciliation process to end subsidies and the individual mandate and lift the Cadillac tax levied on high-price health plans. The process would allow them to bypass Democrats' only remaining means of blocking repeal efforts once Trump takes office, a Senate filibuster, as long as they can argue those changes affect the federal budget.
However, many provisions of the law can’t be repealed via reconciliation, and many parts of House Speaker Paul Ryan’s (R-Wis.) replacement plan can’t be enacted via conciliation, Zeke Emanuel, a senior fellow at CAP, told reporters on a press call Nov. 16.
Republicans likely will include in any repeal measure a one- or two-year delay to give them time to implement a replacement plan, Gail Wilensky, who directed Medicare and Medicaid programs under President George H. W. Bush, said during a talk hosted by the Kaiser Family Foundation Nov. 16.
The ticking clock could motivate Democrats and industry players to support the Republicans’ health agenda, she said.
House Republicans appear to believe immediate repeal of some parts of the ACA will help bolster their plans to replace key aspects of the law. Rep. Michael Burgess (R-Texas) told Bloomberg BNA that lifting ACA provisions such as the individual mandate would force insurance companies to work with Republicans on a replacement.
“Right now they’ve got no incentive to talk,” he said. “You’ve got to buy what they’re selling, so there’s no incentive to make a product people want to buy.”
Trump and other Republican leaders want to keep certain parts of the law intact, namely allowing people under 26 years of age to stay on their parents' health plan and preventing insurers from charging people with health conditions more than the healthy.
Ryan’s replacement plan looks to replace the ACA’s subsidies for individuals with tax credits and expand health saving accounts. He has also promised to promote high-risk pools, subsidized insurance plans for people who might otherwise be unable to afford coverage.
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