By Kristen Mitchell
Congress has taken the first steps toward repealing President Barack Obama’s signature health care law, the Affordable Care Act, a move many experts say would hurt the most vulnerable Americans.
The Senate passed a budget resolution last week that instructs congressional committees to begin working on legislation to repeal major portions of the ACA. The House of Representatives approved the same measure Friday. The votes were largely along partisan lines. Congress will next need to develop a reconciliation bill that could be used to repeal parts of the ACA, which only needs to be approved by a simple majority.
During a town hall event at GW on Thursday, Speaker of the House Paul Ryan (R-Wisc.) said Congress plans to put a new health care plan into action within the first 100 days of the new administration.
Leighton Ku, director of the GW Milken Institute School of Public Health Center for Health Policy Research, spoke to GW Today about how repealing the ACA would affect the 20 million people who depend on it for medical care.
Q: What would a repeal of the Affordable Care Act mean for the millions of people who have received coverage under President Obama’s signature law?
A: If the Affordable Care Act (Obamacare) is repealed without replacement, then the number of uninsured Americans could double, rising by 20 to 30 million, mostly people from low or middle income families. They would have a much harder time getting medical care, which could lead to health problems because they don't get care or get it too late. In addition, there could be broader repercussions that affect those who are still insured, because the loss could create problems for insurance plans, hospitals and doctors' offices. The effects could be gravest for those who have the most serious health problems, such as diabetes, cancer or serious mental health problems.
Here at GW, we recently conducted analyses that found that repeal could also cause the loss of 2 to 3 million jobs. After all, the ACA includes hundreds of billions of dollars that are used to support health care and this in turn triggers economic and employment growth across the nation. Given that President-elect Donald Trump has said that he wants to create millions of new jobs, this could be a very bad way to begin his term in office.
If there are replacement policies developed by Congress, then the outcome will depend on what those replacement policies are. At this point, we do not really know what Congress or the Trump administration will try to propose and advance.
Q: The Senate rejected a proposed amendment that would ensure coverage for people with pre-existing conditions. How would losing that protection affect patients?
A: I don't think the action on the budget bill reflects what the final policy will be. The budget resolution was largely a procedural bill without any specific detail. My impression is that Republican leadership just did not want to include any specific provisions at this early stage in the game. I think it seems unlikely that Congress will do away with Obamacare provisions that guaranteed coverage for people who had pre-existing conditions, although it might be changed somewhat. This provision was popular with the public, with most in Congress, and President-elect Trump has also signaled support.
If I'm wrong, and we eventually repeal provisions about pre-existing conditions, this would mean that people who have insurance could be denied care for serious medical problems. That is what used to happen a few years ago until the ACA fixed that tragic policy flaw.
Q: The ACA permitted young adults to stay on their parents’ insurance until they were 26, but the Senate Republicans rejected an amendment that would continue that coverage. How would this affect young people?
A: At the end of the day, I think it is unlikely that the young adult coverage provisions will be overturned. These are popular provisions with broad bipartisan support. But if I am wrong, and the ability of young adults to be covered in their family’s policies is eventually cancelled, then young adults--like many GW students and recent graduates--will find that it becomes more expensive for them to get good insurance coverage and, as a result, may go without medical care. But I hope this doesn't happen.
Q: Republicans plan to repeal and replace the ACA, but no formal plan on what the replacement would be has been presented. Without a replacement ready to go, do you think Congress should move forward with this plan?
A: It would be irresponsible for Congress to pass or for President-elect Trump to sign a repeal bill that does not have clear and effective replacement policies. In addition to the risk that this could double the number of uninsured and create great problems for hospitals and other health care providers, it could create much broader economic problems, as I described above.
The problem is that there is no clear consensus among Republicans about what a replacement policy should look like. Some of the policies advanced could be very expensive, but not do much to help those who might lose health insurance coverage or those who might lose their jobs. If Obamacare is repealed, we not only need a replacement policy, but also we will need an effective replacement policy that continues to help those who are vulnerable and that continues to strengthen the economy and employment. Mr. Trump has said that he will propose a plan in which there will be "insurance for everybody," but not details are available and some are skeptical that such a plan could be enacted. We will need to be careful about the details of the legislation and not be misled by political rhetoric on either side.
In the end, the real question is not which political party wins or loses, but what we can do to help millions of Americans get access to good and affordable health insurance and health care.
