House Speaker Paul Ryan has said repealing the Affordable Care Act – or Obamacare – is a day-one priority for President Donald Trump and Republicans have already taken the first step towards repealing it.
On the other side of the aisle, Democrats are worried about the negative consequences of repealing the ACA without a viable replacement. A report from the Congressional Budget Office released in early January says repealing ACA would leave 18 million people uninsured across the nation, and would raise prices on healthcare premiums.
Michael Morrisey, with Texas A&M’s School of Public Health, says that if the ACA were repealed most people would continue to have health insurance through their employers, but the expansion of the Medicaid program would disappear and premiums for self-coverage would be dependent upon expected health status.
“In many ways you would go back to health insurance Ex Ante,” Morrisey says.
Several obstacles stand in the way of total repeal, Morrisey says, and the most Republicans can do for now is repeal elements of ACA through budget reconciliation.
“Republicans certainly haven’t coalesced around what exactly they want as a replacement,” Morrisey says.
In order to repeal ACA, Morrisey says that Republicans would have to have the backing of several Democrats in the senate. The best way to do this would be to propose an alternative that addresses some of the negative aspects of ACA and keeps premiums low for everyone.
“The serious issue [with ACA] is that sicker people have disproportionately joined the exchanges,” Morrisey says. “That’s one of the reasons that premiums have gone up and a lot of carriers have dropped out.”
But providing coverage for people who are sick while keeping low premiums for people who are healthy is a tricky matter, Morrisey says.
One of the proposals for replacement is to use high-risk pools, where people with preexisting conditions would be put into their own pool that would be subsidized by a substantial amount.
By having the highest-risk people pool their funds for coverage, Morrisey says insurance companies can keep premiums low for others.
However, there’s another challenge with this option.
“One of the challenges in setting up a high-risk pool of this sort is deciding who is sick enough to be part of it,” Morrisey says. “Prior to the ACA, if you were turned down for coverage by one or two insurance carriers, depending on state law, you were eligible.”
Morrisey says technical issues like these are some of the problems that come with the creation of a replacement plan.
For now, House Democrats are fighting to keep ACA in place. At the Inauguration ceremony in D.C., they wore blue pins as symbols of their protest against its repeal.
Written by Morgan O’Hanlon.