A partial repeal of the Affordable Care Act without an adequate replacement plan could lead to nearly 59 million Americans without coverage by 2019 — resulting in a higher uninsured rate than before the law commonly known as Obamacare was adopted in 2010, according to a report released Wednesday by the nonpartisan Urban Institute.
The report analyzed the impacts of a partial repeal of Obamacare by Congress through a budget procedure known as reconciliation, which was attempted last year and would allow legislators to eliminate key components of the law, including Medicaid expansion, financial aid for low- and moderate-income Americans to buy ACA plans and the requirement that people buy insurance or pay a fine.
But without an adequate replacement, the study’s authors note, a partial repeal through reconciliation would reverse the government-subsidized coverage gained by an estimated 22.5 million Americans under the law while also destabilizing the private insurance markets where consumers purchase their own health plans outside of work — resulting in an additional 7.3 million uninsured.
Add the estimated 28.9 million people who will remain uninsured under Obamacare, and the number of Americans without health insurance would skyrocket to nearly 59 million people in 2019, or 21 percent of the non-elderly population, according to the study.“This scenario does not just move the country back to the situation before the ACA. It moves the country to a situation with higher uninsurance rates than before the ACA,” the authors wrote.The e-study predicted that repeal through reconciliation would cause a “near collapse” of the non-group health insurance markets as consumers would lose or drop their coverage, leaving only those who need insurance the most and therefore cost more to cover. Insurers would take on greater losses, forcing them to raise premiums and driving many insurance companies out of the market — a scenario that already has happened to a lesser degree on the ACA exchange in Florida and other states.
Miriam Harmatz, an attorney with Florida Legal Services, a nonprofit legal aid group that advocates for increased coverage, said the Urban Institute report places the risks of an Obamacare repeal without replacement in stark terms — especially in Florida, where an estimated 1.5 million people have signed up for an ACA plan in 2016.
“It’s really powerful and indisputable data now that repealing the Affordable Care Act without having a replacement plan is going to create absolute chaos in the healthcare system in Florida,” she said.
In Florida, which has not expanded Medicaid eligibility, more than 90 percent of people enrolled in an ACA plan receive about $305 a month in financial assistance to help reduce their monthly premiums, according to the Department of Health and Human Services. An estimated 371,000 people in Miami-Dade are enrolled in an ACA plan for 2016.
Harmatz said the ACA’s financial assistance adds up to a significant amount of federal funds flowing into the Sunshine State — about $5.2 billion a year, according to a recent study from the nonprofit Kaiser Family Foundation, a health policy think tank.
“It would be a catastrophic cost shift to local government,” she added, noting that the state alone cannot make up a loss of billions in federal funds.
While the Urban Institute contemplates a partial repeal of the ACA without a replacement, Republicans in Congress and President-elect Donald Trump have indicated that they aren’t going to just strip millions of Americans of their health insurance without a transition period.
In addition, Trump has said he wants to keep portions of the law, though he also has vowed that on “day one” of his administration he will ask Congress to deliver a “full repeal” of President Barack Obama’s signature domestic policy achievement.
Budget reconciliation would eliminate the requirement that most Americans buy coverage or pay a fine — perhaps the least popular part of the law — while leaving in place some parts of Obamacare that most people like, such as the prohibition on denying coverage due to a prior medical condition.
Whatever path Trump and congressional leaders take to repeal the health law, however, they will be hard pressed to maintain or increase the health insurance coverage gains achieved under Obamacare without facing some difficult choices, according to the Urban Institute study.
“To replace the ACA after reconciliation with new policies designed to increase insurance coverage,” the study authors wrote, “the federal government would have to raise new taxes, substantially cut spending, or increase the deficit.”