ACA repeal would come with political consequences

Dive Brief:

  • More than 9 million people receiving an average monthly advanced premium tax credit of $291 will lose these subsidies if the Affordable Care Act (ACA) is repealed, according to data from the Kaiser Family Foundation published Monday.

  • More than 6 million people receiving ACA subsidies live in states that president-elect Donald Trump won in the presidential election, according to an analysis from Greg Sargent at The Washington Post.

  • Regardless of the path Republicans take toward health reform, passing legislation that reduces health insurance coverage could have significant political ramifications.

Dive Insight:

Until Republicans establish details to a health reform plan, questions will remain about insurance for the 20 million patients covered under the ACA. Any replacement plan will likely have an effect on their coverage and not taking their concerns into account could come back to haunt Republicans in the polls.

Currently available health reform plans proposed by Republicans would generally reduce coverage, Sarah Kliff wrote for Vox in November. For instance, some economists predict the plan released by House Speaker Paul Ryan (R-WI) will reduce coverage by four million patients or more. This would likely be the result of reduced Medicaid spending.

Although Republicans seem likely to move forward with repeal, some have softened their stance on the ACA since the election. The share of legislators who advocated for full repeal fell from 32% in October to 26% in November, according to data released from Kaiser Family Foundation on December 1.

Among the general public, 49% want to keep or expand the ACA, 26% want it repealed, and 17% want it scaled back. Nearly two-thirds who want it repealed want it replaced, either before or after repeal occurs.

It seems Republicans have a long way to go to establish consensus around the details of health reform and it is possible no replacement plan materializes for quite some time. A repeal without replacement could throw the insurance market into imbalance. If that happens, “we will be looking at a very big mess, heading right into the 2020 elections -- including in a lot of red and swing states,” Sargent wrote.

Filed Under: Health Law Policy & Regulation
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