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Experts: ACA repeal would double uninsured by 2019, send U.S. health care "someplace worse."

In a briefing sponsored by Democratic senators, health policy wonks said that if the Trump administration repeals Obamacare as quickly as promised, the number of uninsured Americans will double by 2019 and in some ways, American health care would be worse that before the Affordable Care Act (ACA) passed.
On Dec. 9, Democrats on the Senate Health, Education, Labor, and Pensions (HELP) and Finance committees hosted a briefing on what they called the "damaging and immediate impact of the Republican plan to repeal the Affordable Care Act without a replacement."

Though the state of policy is fluid, it is expected that the Republican Congress, with no serious veto threat from incoming Republican President-elect Donald Trump (who during the campaign promised repeal within 100 days of taking office), will strike down the law quickly; however, reports suggest a replacement will not be ready when they do.

At the briefing in the Dirksen Senate Office Building in Washington, D.C., a panel health policy experts from The Urban Institute, the National Partnership for Women and Families and the Center on Budget and Policy Priorities speculated that the Republicans' new bill would be substantially the same as the repeal bill passed by Congress in January 2016 and vetoed by President Barack Obama shortly thereafter.

Under such a plan, they said, there would be no mandates and no sources of revenue for the ACA insurance exchange, though insurer requirements such as guaranteed issue and preventive care without cost-sharing would remain in place. Given that the small GOP majority in the Senate would make full repeal virtually impossible,  lawmakers would be restricted to budget-related "reconciliation" changes under Congressional rules.

The experts reminded reporters that premiums for 2017 are fixed, so a repeal that immediately removed financial incentives while still requiring increased coverage would cause a "serious disruption in the private insurance market." If the Trump administration also, as expected, ceases to defend House v. Burwell, Republicans' lawsuit against the Obama administration for making reinsurance and other payments to insurers that the Republicans claim are illegal, payers stand to lose billions more. Under these circumstances, the experts said, payers are likely to retreat from the low-income individual insurance market currently served by the subsidized exchanges. 

The panel also claimed other planned Republican cuts to government programs such as SCHIP and to non-governmental health care organizations such as Planned Parenthood would further reduce care to the needful.

According to the Urban Institute's white paper, "Implications of Partial Repeal of the ACA through Reconciliation," the number of uninsured Americans would under these conditions rise from its current 28.9 million to 58.7 million and "82% of the people becoming uninsured would be in working families. ... To replace the ACA after reconciliation with new policies designed to increase insurance coverage, the federal government would have to raise new taxes, substantially cut spending or increase the deficit."

"We will not go back to where we were [before Obamacare] but to someplace worse," said one expert.
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