Repealing the ACA (aka Obamacare): The Good, but Mostly the Bad and the Ugly

First mistake: Thinking that if you don’t use the insurance marketplace for the ACA you’ll be unaffected by a repeal. Second mistake: Not spending some time sussing out the domino chain of what will fall with a repeal. (Third mistake: the 53% of self-identified Republicans who don’t realize that repealing Obamacare will eliminate the Medicaid expansion).  The good? Insurance companies could do whatever they feel like! Also, people who choose not to have insurance will no longer have to pay $695 when they file their taxes. But the rest…not good.

The truth of the matter is, whether you love it or you hate it, Obamacare is affecting all of us in ways we’d probably miss if it disappeared. Far more than the 20 million people currently insured under the ACA would be feeling the effects of a repeal. Senior citizens pay less for Medicare coverage and for prescriptions. As a woman myself, I’m particularly tuned into the fact that now contraceptives, mammograms, pap smears, and other women’s health procedures must be fully covered by insurance. Colonoscopies? Covered. Cholesterol tests? Covered. Annual check-ups are covered. For all of us. And even small business employers have gained – they are no longer stuck with super high premiums for their employees who are older or sicker.

For their part, the Republicans frankly seem to have no idea what they’re doing. They’ve backed off their plans for swift repeal slightly (as it became clear people were getting antsier and angrier about the prospect), but initially they’d planned to begin by eliminating the provisions that affect spending and revenues : Medicaid expansion, taxes, and mandates that all individuals obtain coverage and that large employers provide it. The federal subsidies would also be gone.

This is what a full repeal would look like:

Medicare:

  • Post Obamacare, there would be higher premiums, deductibles, and cost-sharing for the almost 60 million senior citizens and disabled Americans enrolled. And welcome back, “donut hole.” Repealing Obamacare would increase Medicare spending by $802 billion over 10 years. (Fun fact: the Congressional Budget Office has published the budgetary and economic effects of repealing the ACA, and Congress voted to stifle the information.)
  • The provision covering preventative benefits for Medicare enrollees would disappear.
  • Since the ACA was passed in 2010, more than 11 million people have saved, on average, more than $2,100/person on prescription drugs. Wave by to this type of savings, too.

Employer-sponsored Insurance:

  • That employer mandate that requires companies who employ at least 50 people provide their employees who work more than 30 hours a week with health insurance would be yesterday’s news.
  • Now, to be fair, this wouldn’t have a major impact on the ~150 million workers who have insurance through their jobs because most large employers offer coverage for full-time workers, BUT…
  • Setting the bar at 30 hours a week encouraged some employers to extend health insurance coverage to more staff members, as 30 hours had formerly been considered part-time. If repealed, those companies could go back to covering only those workers who work 40 hours a week, resulting in those newly insured employees losing their coverage.
  • In the same vein, employers would no longer have to keep children on their parents’ plans until they turn 26. (When I worked immediately after undergrad it was at a tiny company that did not give me health insurance. If it hadn’t been for my dad’s insurance, I’d have been walking on a health tightrope for three years. Apparently there were 2.3 million of us who had insurance because of this.)
  • Preventative care like mammograms and colonoscopies would no longer be included (back to paying copays or more).
  • Companies will fewer than 50 employees would find themselves back where they began – insurance companies could refuse coverage to workers with preexisting conditions and opt not to cover maternity, mental health, and prescription drugs. Insurers can also go back to charging older workers premiums that are more than three times those charged to younger workers.

Individual Market (ALL insurance providers, not simply those gained through ACA):

  • Have a preexisting condition? You might find yourself back out in the cold, sans insurance. If you’re sick, you may see your costs skyrocketing.
  • Insurers can go back to imposing annual or lifetime caps on benefits, sooo….we could find ourselves “running out” of insurance. Not to mention, the ACA imposed limits on how much out-of-pocket spending would be required of an individual. Repeal the ACA and you’re looking at paying a LOT more out-of-pocket.
  • With respect to the insurance exchanges, lower-income people will be looking policies costing more than their income. The ACA enabled lower and middle-income individuals to buy policies for less than 10% of their income.
  • 10.4 million people purchased insurance through the exchanges as of June of last year. Another 6.9 million had purchased individual policies outside of the exchanges.
  • A note: Trump has said that insurers will be required to cover pre-existing conditions as long as the individuals are continuously insured. No insurance or a brief uninsured period? You’re looking at higher premiums or applying for policies in state-based high risk pools.

Medicaid – This is a big one that people often don’t think about/forget was part of Obamacare:

  • Prior to the ACA, Medicaid enrollees primarily consisted of low-income children, pregnant women, parents, the disabled, and the elderly.
  • After the ACA, the program was opened to low-income adults with incomes of up to 138% of the poverty line ($16,400 for a single person*) in states that chose ot expand their Medicaid programs. [*Can we just take a minute to think about how crazy it is that $16,400 is 138% of the poverty line? Like, wtf.]
  • 31 states plus D.C. have expanded their Medicaid, which has resulted in an increase of 17 million enrollees since 2013.
  • A full repeal of Obamacare will be a huge “F you” to the poorest Americans who will have no insurance.

The Sources – in addition to those linked within the post (to get you started, but I encourage doing some digging of your own. There’s a lot I didn’t address. For example, I didn’t even get into the fact that although they are high, premiums under Obamacare rose much more slowly than they otherwise would have. I can totally get into that, though.):

Also just run a search on “cost of appealing Obamacare” and “effect of repealing the ACA” if you’re interested. And read the reports from the Congressional Budget Office.

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