قالب وردپرس درنا توس
Home / Insurance / What if Republicans had succeeded in repealing the Affordable Care Act?

What if Republicans had succeeded in repealing the Affordable Care Act?



By Andrew Sprung, David Anderson and Louise Norris

On November 10, the Trump administration will ask the Supreme Court in oral arguments to declare the Affordable Care Act unconstitutional – and invalidate the law in the midst of a pandemic, leaving an estimated 23 million people uninsured. When Republicans rushed to confirm Amy Coney Barrett’s nomination to the Supreme Court, Senate Majority Leader Mitch McConnell argued that “no one believes” the court will repeal the law – which means, as many hard-pressed Republican officials have also indicated, that Republicans do not want do it.

But the ACA’s repeal has been Republican policy since President Obama signed the bill in March 201

0. In 2017, a Republican House and Congress came not far from repealing the ACA’s core program, and 90% of Republicans in Congress voted for a repeal. Where would they be now if they had succeeded? How many more Americans would be uninsured, and what options would be available to the millions who have lost job-based coverage since the pandemic reached our shores?

Republican “health care reform”: Cut ACA subsidies and Medicaid

In May 2017, the Republican House passed the American Health Care Act (AHCA). The Congressional Budget Office (CBO) predicts that if the bill passed, 19 million fewer Americans would be insured by 2020 and 23 million by 2024. The CBO expected similar coverage losses for the Better Care Reconciliation Act (BCRA), the accompanying Senate bill. After nine Republican senators stepped down to help defeat the BCRA, a “narrow” repeal law that would have opened the door to a revised bill by a single vote failed when John McCain unexpectedly turned his thumb down.

Both AHCA and BCRA would have greatly reduced ACA’s premium subsidies in the individual health insurance market and would have made the available coverage virtually unusable for millions of low-income earners by eliminating ACA’s cost-sharing reduction subsidies. But both bills did their deepest damage by eliminating federal funding for the ACA Medicaid expansion, which extends Medicaid entitlement to all adult citizens and some legally present non-citizens with incomes of up to 138 percent of the federal poverty level (this year it is $ 1,467 per month for an individual). The CBO predicts that under both bills, the expansion registration would be wiped out, reducing the Medicaid registration to 8 to 9 million this year and by 14 to 15 million as of 2024.

Both bills would also have fundamentally changed Medicaid by turning federal funding into a ceiling with a ceiling that would grow more slowly than medical inflation. Under such per capita ceilings or block grants, states would now bear all the cost risk of pandemic and recession even when state revenues have collapsed.

The impartial Center for a Responsible Federal Budget estimated that BCRA would reduce Medicaid spending by more than $ 2 trillion over 20 years, gradually weakening coverage for tens of millions who were not disqualified by repealing the ACA expansion.

Following their failed efforts to abolish it, Republicans cut off the margins of the ACA’s core program: the subsidized private plan market and the Medicaid expansion. According to the Federal National Health Interview Survey, the national uninsured share has increased from the lowest ever at 9.0% in 2017 to 10.3% in 2019. Yet, in February 2020, just before the pandemic caused economic devastation, 12 million Medicaid adults enrolled were qualified according to ACA’s expansion criteria, and 9.2 million enrolled in ACA’s private plan market received federal subsidies that paid for an average of 76% of their premiums.

45 million uninsured – and climbing

Had either Republican bill on “repeal and compensation” been passed in 2017, the uninsured population in February 2020 would almost certainly have risen to about 45 million, according to the CBO’s forecasts – about 50 percent higher than its actual level. The pandemic would undoubtedly have accelerated the rise to 49-50 million uninsured as the CBO estimated by 2024.

Instead, when the pandemic struck and triggered tens of millions of job losses, the ACA’s core program stood as a gaping but still significant defense against massive increases in the uninsured population. Yeoman’s work has been carried out by the Medicaid expansion. Medicaid eligibility is determined by current monthly income, so that someone who loses a middle-class job during the pandemic can immediately qualify.

By June, according to the Center for Medicare and Medicaid Services, Medicaid enrollment had grown to 75 million – an increase of 4 million since February. The number of enrollments has continued throughout this pandemic. It is probably now at 78 million, about 10 percent above the February sum. Among those made eligible by the ACA Medicaid expansion, the registration increase is close to 20%. At least 14 million current Medicaid employees would not be eligible in a “Repeal and Replace” world.

The ACA marketplace offers more limited protection – due to both the administrative burden of verifying eligibility for registration and the determination of subsidies through annual income instead of monthly income. Still, according to an estimate, marketplace registration is probably about 1 million higher than it would have been in the absence of the pandemic. Regulatory authorities have prepared the marketplaces for significant new registrations during the autumn open registration period.

The uninsured population has undoubtedly increased during the months of an unprecedented job loss triggered by the pandemic. But it would have risen faster and further – and from a much higher base – if Medicaid expansion and the current ACA market had been eradicated.

Even with the likely affiliation with Trump’s nominee Supreme Court Amy Coney Barrett, who has held that the Supreme Court wrongly declared the law constitutional in 2012, McConnell is right in predicting that the court will not annul the entire law. But that’s what the Trump administration and the 18 Republican justice ministers and governors prosecuting the lawsuit are asking for. The ACA repeal must be seen as the policy of a party that at its national convention refused to produce any platform other than a statement of credibility to Trump.

Andrew Sprung writes about health care policy on his blog, xpostfactoidand at Otherpublications.

David Anderson, MSPPM, is a research assistant at Duke University’s Margolis Center for Health Policy.

Louise Norris is a partner in the Colorado Health Insurance Insider, and also writes about health insurance and health reform healthinsurance.org and very well.


Source link