Update: Since this piece was originally published on January 6, 2017, Congress has taken additional steps in the process to repeal the ACA. In the early hours of January 12, 2017 the Senate voted (51-48) to pass its budget resolution, including instructions to repeal the ACA, followed by a House vote (227-198) to pass its version. The committees can now begin drafting their repeal legislation, which will need to be voted upon by both chambers.
By passing this budget resolution, Congressional Republicans have confirmed they aim to take swift action to repeal the ACA. Congressional leaders continue to pursue repeal of the ACA without having a replacement plan. As noted below, this strategy is dangerous for numerous reasons.
On the first day after the 115th Congress was sworn in, Republican leaders fired their opening salvo in a plan to repeal the Affordable Care Act (ACA). As expected, their strategy is to use a budget process known as reconciliation, which allows the Senate to pass legislation with only 51 votes –a simple majority – rather than a filibuster-proof 60 votes. The first step in this process is for the House and Senate to pass budget resolutions; these were released this week.
Congressional Republicans do not have a plan to replace the ACA; rather they hope to rush through a repeal plan with a delayed implementation and then figure out an alternative plan down the road. This is a terrible idea that threatens the health insurance of millions of Americans—and one that defies the clear evidence of the ACA’s success, particularly among low-income children, families, and individuals.
Implementation of the ACA has resulted in a historic number of Americans having health insurance. A repeal of the ACA would be worse than reversing course – it would actually result in more people being uninsured than before the ACA. A repeal would more than double the number of people without health coverage, forcing 30 million to lose their insurance.
Repeal of the ACA would have particularly dire consequences for the 4.4 million children who would become uninsured. Health insurance for children has long-term positive outcomes, such as reductions in infant mortality and childhood deaths, improved health, and reduced disability. But there are subtler effects, too: expanding health coverage for low-income children improves high school and postsecondary success, and also employment over the long haul. Plus, children’s life chances are improved when parents are able to get the care they need, like treatment for depression (which is widespread among low-income mothers of young children). In states that have expanded Medicaid under the ACA, many more parents have health insurance, making access to treatment for behavioral health or substance use disorders more available, which helps parents’ own health and improves outcomes for their children.
In addition to the direct impact on individuals and families, health care providers are at increased financial risk if the ACA is repealed. More uninsured patients will increase providers’ uncompensated care, a particular risk for hospitals. Multiple provider organizations, including the American Academy of Pediatrics and the American Medical Association, have urged Congress to prevent people from losing health insurance.
Not all Republicans are in agreement that a quick repeal of the ACA is a good policy decision – particularly without a concrete plan to replace it. Governor Snyder of Michigan has been outspoken about the importance of the ACA, and particularly Medicaid expansion, for the people of his state. Governor Kasich of Ohio recently touted the benefits of Medicaid expansion – mental health care access, drug treatment to respond to the opioid epidemic, care for chronic health conditions, and job creation. A new report to the legislature highlights that in many cases, access to affordable health care through Medicaid allows Ohioans to become and stay employed. Kasich expressed concern about what will happen to the 700,000 residents who have enrolled in Medicaid – a concern for the 10 million people across the country who have received affordable health insurance due to Medicaid expansion. Snyder and Kasich are joined by the conservative-leaning American Enterprise Institute in voicing their concerns about repealing without replacing.
A new Kaiser Family Foundation poll released January 6 found that only 20 percent of Americans support repealing the ACA without a replacement enacted at the same time. Even among those who think the ACA should be repealed, less than half support repeal without replace. The millions of Americans who receive insurance through Medicaid expansion, who have bought insurance through the exchange, or who have a pre-existing condition, are rightly worried about what will happen to them.
Republican leaders and members of the U.S. Senate and House should listen carefully to those voices within their party who can see past the politics and identify the real danger to people, families, communities, and providers if the ACA is repealed. Everyone’s time would be better spent talking about how to improve the ACA through smart policy changes, rather than risking affordable health insurance for 30 million Americans.
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