Anxiety among both the public and lawmakers continues to rise as House and Senate Republicans last week took the first step toward their ultimate goal of repealing the Affordable Care Act. At least 5 Republican Senators have stated their support for having a replacement plan to go along with any repeal legislation. Several Republican governors who have expanded Medicaid under the ACA have also expressed their concern over a model that does not include replacement legislation. Governors John Kasich and Rick Snyder of Ohio and Michigan, respectively, have been particularly vocal; their states stand to lose a combined $86 billion in federal funding if the ACA is repealed.
Efforts to repeal the ACA were further muddied on January 17th, when the Congressional Budget Office released its report which details the impact of repealing the ACA without replacement legislation. The CBO is the non-partisan Congressional office tasked with providing independent analyses of budgetary and economic issues to support the Congressional budget process. Highlights of the report include:
- 18 million people could lose their health insurance coverage within the first year, and 32 million could lose coverage within ten years, between Medicaid and the individual insurance market
- Destabilization of the individual insurance market due to the elimination of the individual mandate and premium subsidies for low-income individuals resulting in a “death spiral”
- Half of the country would be living in areas with no insurer in the individual market in the first year, and three-fourths would live in such areas by 2026
- Premiums for health insurance coverage purchased on the individual market would be 20 percent to 25 percent higher in the first year
Congress has a daunting landscape as it moves ahead with its plans to repeal and replace the ACA. It is a near certainty that the Affordable Care Act will be altered in some way. It is less certain what those alterations might look like. ANA stands by its core principles and demands that any replacement legislation reflect our principles: universal access to a standard package of essential health benefits for all citizens and residents; utilization of primary, community-based and preventative services while supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services; the economical use of health care services with support for those who do not have the means to share in costs; and a sufficient supply of a skilled workforce dedicated to providing high quality health care services.