The Republican plan to repeal most of the Affordable Care Act (ACA) without replacement would double the number of uninsured people to 59 million and leave the nation with a higher uninsured rate than before the ACA, a report shows.
The Urban Institute estimated the impact of an approach similar to the reconciliation bill that President Obama vetoed in January 2016, which would have repealed after two years the ACA’s Medicaid expansion and subsidies to help low- and moderate-income people buy coverage in the insurance marketplaces. Those changes, alone, would raise the number of uninsured by 22.5 million when they took effect in 2019, Urban found.
Another 7.3 million people would become uninsured in 2019 because, together, the bill’s immediate repeal of the individual mandate, eventual elimination of marketplace subsidies, and retention of ACA protections for people with pre-existing conditions would cause the individual insurance market to “virtually collapse.”
According to Urban’s analysis, the number of uninsured children under the age of 18 would increase by about 4 million. The child uninsurance rate would more than double, increasing from 4% to 9%. States will likely have more flexibility to limit children’s coverage under most conceivable scenarios in 2019, and they may well have less federal money to pay for it, which may be an incentive to do so. Eliminating premium tax credits and cost-sharing assistance would make coverage unaffordable for many of the people currently enrolled, causing them to drop coverage. Those with the fewest health problems would drop their coverage fastest, the report said.
Eliminating the individual mandate penalty would reduce the incentive to enroll for healthy people who can afford coverage, the report said.
Insurers would remain subject to the requirement to sell coverage that meets adequacy standards to all would-be purchasers, and they would remain subject to the prohibition against charging higher premiums or offering reduced benefits to those with health care needs, the report said.
And, the impact of that collapse would be immediate, with 4.3 million people dropping coverage and becoming uninsured in 2017 due to the individual mandate’s repeal, the report said.
Other key findings:
- The vast majority (82%) of people becoming uninsured in 2019 would be in working families and would not have college degrees (80%).
- More than half (56%) of those losing coverage would be non-Hispanic whites.
- The doubling of the number of uninsured would cause demands for uncompensated health care to skyrocket by $1.1 trillion over 2019-2028, placing heavy new burdens on state and local governments and health care providers.
If the repeal bill that congressional GOP leaders passed last year (which the president vetoed) is a guide — as GOP leaders have said it will be — the repeal bill that they bring up for a vote early in 2017 will immediately eliminate the ACA’s individual and employer mandates. This means some people who are now enrolled — particularly healthy people who would no longer have to pay a penalty for lacking coverage — would drop coverage. (Some employers as well could stop offering coverage to their workers.)
As a result, it’s likely that some insurers would drop out of the insurance marketplaces in 2018, with those that remain raising their premiums significantly since the people they cover will now be less healthy than in previous years. The premiums could rise to levels that most people who don’t qualify for subsidies cannot afford.
The plans from House Speaker Paul Ryan and House Budget Committee Chair Tom Price, who has been nominated to be the next HHS Secretary, would provide tax credits that vary by age but, unlike the ACA, not by income, and wouldn’t take the actual cost of coverage into account, the report said.
The maximum tax credit for people 51 and older in the Price plan would be $3,000 a year, far less than is needed to enable many people with modest incomes to afford coverage in today’s market. This would be particularly problematic for the poor and near-poor who now qualify for coverage under the ACA’s Medicaid expansion and either don’t pay premiums or pay premiums that are very low in relation to their income, the report said.
While coverage would likely be cheaper under Republican plans, especially for healthier people, that’s because their plans would generally cover significantly fewer benefits and have higher out-of-pocket costs, the report said.
Info: https://goo.gl/CH3yHz (report).