Payers might flee insurance exchanges if Republicans repeal the ACA with no replacement plan implemented at the same time, causing significant disruption in the individual insurance market, according to a new analysis from the American Academy of Actuaries (AAA).
To add to the GOP worry over a repeal-and-replace plan, a recent Urban Institute report estimates providers could feel the burn of a $1.1 trillion increase in uncompensated care from 2019 to 2028 if the ACA is repealed via reconciliation.
- These reports add to the bevy of warning shots being fired at the GOP regarding consequences if the ACA is repealed without a replacement plan in place. On Tuesday, research from the American Hospital Association and the Federation of American Hospitals could if legislation for an ACA repeal is passed without simultaneously implementing a replacement plan, it could cost hospitals $165.8 billion in federal payments through 2026.
The Urban Institute report considers what would happen if Republicans use the budget reconciliation process to repeal parts of the ACA without making any other changes. Using last year's reconciliation bill as a guide, this route could eliminate Medicaid expansion, subsidies for coverage, and individual and employer mandates while leaving requirements on guaranteed issue, community rating, and standards for coverage. This scenario could lead to uninsured rates even higher than pre-ACA levels, according to the analysis.
Republicans could repeal the ACA and delay the effective date of repeal, but this is also likely to have adverse outcomes, according to the AAA. The impending threat that risk pools deteriorate in the individual market and uncertainty around future policy would likely scare payers away from participating on ACA exchanges. Premium costs could increase and uninsured rates could likely follow.
Even if Republicans implement one of several proposed ACA replacements, uninsured rates are likely to rise. Economic analyses of seven alternative health reform plans suggest that they would reduce the number of people with health insurance if implemented, according to Vox's Sarah Kliff.
It has been a little more than a month since the election that will give Republicans control of Congress and the White House in January. President-elect Donald Trump and other Republicans have promised to take on health reform early in 2017. If they stick to their word, they are running out of time to agree to plan that won’t leave millions without insurance.