This week, the Urban Institute (the Institute) released a brief discussing the impact of enacting the same partial repeal of the Affordable Care Act (ACA) advanced by Congressional Republicans in 2016. This repeal (H.R. 3762), using the legislative reconciliation tool, was vetoed by President Obama, but it is widely believed that President-Elect Trump would be likely to sign an identical bill.
Other estimates account for all of the people who gained health insurance coverage through the ACA, approximately 22 million people through the combination of the Medicaid Expansion and the individual Marketplace. But in this brief, the Institute delves deeper into the mechanisms of the individual insurance market to find that nearly 30 million people would be without meaningful health care coverage if Congress passed this same bill again. This would not be a reversion to pre-ACA levels, but an increase in the uninsured because of damage to the markets.
The partial repeal would damage the individual insurance markets by retaining the rules for insurers without, in turn, requiring individuals to purchase coverage. Insurers would still be required to cover pre-existing conditions, to guarantee issue, and not to base premiums on health status, sex, or age beyond a mandated formula. But individuals would be able to leave the market at any time and return without penalty if and when they need health care. This combination would lead to insurers covering only an older, sicker population as younger, healthier people choose to save money and drop their insurance. Insurer costs would rise, causing them to either raise premiums or to leave the individual market entirely, potentially in the middle of the plan year.
In addition, pulling the current subsidies provided by the federal government to low- and middle-income people for health care coverage would hasten the decline of the markets. Medicare Rights is deeply concerned about the implications of repealing the ACA and delaying the development of a meaningful replacement plan, and we will advocate for continued access to affordable coverage for Americans of all ages.