No matter who becomes our next president, changes will be made to the Affordable Care Act (ACA). Democratic candidate Hillary Clinton has promised to repair the law and Bernie Sanders has plans to replace it with universal coverage. GOP candidates Donald Trump and Ted Cruz have both vowed to repeal the law. But will repeal really happen at this point? It’s possible, but not likely. Here’s why.
Since the ACA went into effect in 2010, 20 million people have gained insurance, many for the first time. And uninsured rates are at an all-time low. Repealing the law without a replacement would cause millions of people to lose their insurance, which would be a political nightmare.
With no other options for care, the millions of people who would no longer be insured would return to hospital emergency rooms. In an article in The Hill, former Rep. Bill Owens (D-NY) said, “This will result in tens of billions of dollars in uncompensated care being provided by our hospitals.” Prior to the enactment of Obamacare, uncompensated care provided by hospitals was in the $75 billion to $125 billion range.
Insurers would suffer revenue losses, which would result in increased premiums. They would also be pressured by hospitals for higher reimbursements to make up for the increased costs of uncompensated care.
“The chaos that would ensue in the healthcare system by repealing Obamacare is largely unimaginable, and I suspect not at all thought through by proponents of repeal legislation,” Owens said.
According to Obamacare Facts, repealing the ACA would add $137 billion to the deficit over the next 10 years and result in as many as 24 million people being uninsured by 2024. Repealing the law could cost as much as $6.2 trillion over the next 75 years.
The logistics of repealing the law
Political and budget ramifications notwithstanding, there are additional potential barriers to repealing the ACA. In order for Obamacare to be repealed, Republicans would have to gain control of the White House, the Senate and the House of Representatives. “Unless both houses of Congress and the executive branch are under GOP control, Democrats would be able to block any repeal effort – and the Obamacare trench warfare that’s taken place since Democrats lost control of Congress in January 2011 would continue,” John McDonough, professor of public health practice, Harvard University, said in an article in The Conversation.
McDonough said even if Republicans were able to gain control of the White House and Congress, Senate Democrats could filibuster any legislation to repeal Obamacare. Republicans would need 60 Senators to vote to close the filibuster, which McDonough believes is unlikely. “For this reason, even if they’re in the minority, Democrats could block any straight repeal legislation and compel Republicans to resort to another path,” he said.
What happens if the law is repealed?
If Republicans are successful in repealing Obamacare, it definitely won’t happen overnight. According to Obamacare Facts, some of the things that could disappear right away include the majority of the new benefits, rights and protections, including protections for people with preexisting conditions.
A more likely scenario is that the law will be revised rather than repealed. In a blog post for The Health Care Blog, Paul Keckley said here to stay are the law’s fundamental shift toward provider sponsored risk, increased transparency, connectivity through information technologies, comparative effectiveness studies to discern what works best, and insurance reforms that hold companies accountable for business practices that are understood by all.