Any doubts that repealing the core elements of the Affordable Care Act would have dire consequences for millions of Americans were laid to rest this week by the nonpartisan Congressional Budget Office.
In the first year after repeal, 18 million Americans would become uninsured, the CBO concluded. That number would increase to 32 million by 2026, when insurance subsidies and the expansion of Medicaid also would go away.
In addition, premiums would rise as much as 25 percent in the first year after repeal, and double by 2026, the CBO calculated.
This isn’t some ungrounded doomsday scenario. The CBO and Joint Committee on Taxation reviewed HR 3762, the model for repeal legislation currently under consideration in Congress, which would end both the mandate that individuals purchase health insurance and the subsidies that keep that insurance affordable. It would also end Medicaid expansion, which Maine did not join, but would maintain protections for people with pre-existing conditions.
Without the mandate — including its penalties — and subsidies, fewer people will purchase insurance, thus destabilizing the market, the CBO wrote. The people most likely to remain in the shrinking pool would be the sickest and most expensive to insure. As a result, insurers will have to dramatically raise premiums.
“This nonpartisan report is another startling affirmation of the far-reaching and disastrous consequences that a rushed repeal of the Affordable Care Act would have for millions of Americans and tens of thousands of Mainers,” Sen. Angus King said in a statement Tuesday. “Simply put, this is not a responsible way to govern — and people across Maine are unfairly and needlessly going to pay the price by having their health insurance ripped away and by having to reach deeper into their pockets for vital health services.”
Proponents of repeal will argue that the CBO analysis does not consider a replacement for the landmark health insurance law. That is true — because, so far, no replacement has been revealed. And, given Republican leadership’s push to quickly repeal (and, perhaps, replace) the ACA, it is unlikely the CBO would have time to thoroughly analyze any replacement for its costs and consequences.
As the CBO clearly shows, repealing the Affordable Care Act is foolhardy. But since Republicans are so intent on pursuing this move, logic be damned, they should at least slow down the process to ensure a reasonable alternative is introduced and fully evaluated by the CBO.
Sen. Susan Collins, who voted in favor of a repeal framework last week, is making that request of her colleagues. “I’m pleased to see a growing consensus among members of both the Senate and the House that we must repair the ACA and provide reforms at nearly the same time that we repeal the law in order to protect families who rely on the program and to give insurers time to transition to a new marketplace that is based on more choices for consumers,” she said on the Senate floor Tuesday.
She and Sen. Bill Cassidy, a physician and Republican from Louisiana, are working on an alternative plan that would hand over many decisions about the Affordable Care Act to states. While many more details are needed, this approach is concerning because some governors, such as Maine’s Paul LePage, have shown little interest in extending the reach of health insurance. LePage’s two-year budget plan would, in fact, further reduce access to publicly funded health plans.
The CBO review highlights the need for a thorough discussion and analysis of any politically viable repeal and replacement plan in order to minimize disruptions in health care for tens of millions of Americans.
That takeaway, however, is secondary to the sheer irresponsibility of repealing the Affordable Care Act to begin with.