GOP Obamacare repeal will unleash a health-care calamity on the nation


ObamacareSenate Democrats asked the Congressional Budget Office (CBO) to prepare a report on what would happen if the Republican Affordable Care Act aka “ObamaCare” repeal bill was passed and implemented.

I know you are saying to yourself, “wait, the GOP doesn’t have any ACA replacement plan to score,” but the budget office relied on a 2015 bill that the House GOP actually did pass which is still the basis of repeal efforts.

The result would be to unleash a health-care calamity on the nation. 18 million would lose insurance in first year of Obamacare repeal without replacement, CBO report says:

At least 18 million people would lose health insurance in the first year if Republicans move ahead with plans to repeal major portions of the Affordable Care Act without a replacement plan, estimates a report from the nonpartisan Congressional Budget Office.

The number of people without insurance would grow to about 32 million within the first decade if congressional Republicans follow a 2015 plan to repeal the health-care law without an alternative, the new report says. It also estimates that health insurance premiums for people buying individual non-group coverage would double within a decade, further complicating GOP promises that people will not lose coverage under their plan.

The report was an update of a previous analysis of the 2015 repeal legislation.

The report comes as Republican leaders in Washington are working furiously to tamp down concerns within their ranks that a speedy push to repeal major portions of the law known as Obamacare could create chaos in the insurance markets and provoke a backlash from voters.

Over the weekend, President-elect Donald Trump promised in an interview with The Washington Post that he was nearing completion of a plan to provide “insurance for everybody.” Trump did not provide any details of what that plan would include, but his timeline and promises of coverage for everyone clash starkly with the CBO report estimating that millions of people would lose coverage.

The report increases the pressure on Republicans to come up with a replacement plan that fills in the gaps for Americans covered by the ACA while adhering to GOP principles.

Those “GOP principles” do not and never have included “insurance for everybody” — someone forgot to give the memo to Trump. Pressure mounts on GOP for post-Obamacare plan following CBO report:

Trump waded into the fray over the weekend when he declared that his own replacement plan is nearly complete — touting the goal of “insurance for everybody” and promising “much lower deductibles” for consumers. That pronouncement appeared to come with little consultation with congressional Republicans, and it conflicted directly with plans laid out by Trump’s advisers, including Rep. Tom Price (R-Ga.), his nominee for secretary of health and human services.

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The fact that Trump has begun to sketch out his own health-care proposal has injected a new element of uncertainty in an evolving fight that could have serious implications for other parts of Trump’s policy agenda.

Several Republicans sounded cautious about some of the president-elect’s more sweeping promises and said there had been only limited consultation between the transition team and key congressional committees.

Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) told reporters that it is difficult to commit to providing universal health coverage in any upcoming GOP replacement. In 2012, Hatch said it was a “disgrace” that so many Americans were uninsured, “but we cannot succumb to the pressure to argue on the left’s terms.”

“It would be wonderful if we could do that,” Hatch said Tuesday. “We’ve never been able to do that before.”

Sen. Lamar Alexander (R-Tenn.), who leads the committee before which Price will appear Wednesday, said he has not heard any details of Trump’s plan.

This is very likely because there is no such plan. Greg Sargent of the Washington Post explains, Trump’s Obamacare replacement will be a scam. Here’s how Democrats can expose it.

Trump and his advisers have been saying that no one who currently has coverage under Obamacare will lose it under the GOP replacement. Trump himself recently said that under his replacement, “everybody” will have insurance, adding that “there was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” Top transition adviser Kellyanne Conway recently made similarly nice-sounding noises.

But today, Trump seemed to backtrack on this promise in interviews with Fox News and Axios. While he reiterated that people without money will get coverage, he clarified that he’s considering a mechanism to do this: Medicaid block grants. “We’ll probably have block grants of Medicaid back into the states,” Trump told Fox.

Progressives tend to oppose Medicaid block grants because they are all but certain to get cut, and because states would restrict eligibility requirements. As the Center on Budget and Policy Priorities recently put it, they “would likely eliminate the guarantee that everyone who’s eligible and applies for its benefits would receive them.”

Sargent’s colleague Paul Waldman at the Washington Post writes, The magnitude of the health-care calamity Republicans are about to cause is becoming clear:

On Tuesday, the nonpartisan Congressional Budget Office released a new report that makes clear the magnitude of the health-care calamity Republicans are preparing to unleash on the country. While it doesn’t tell the whole story of this debate, it shows why their effort to repeal the Affordable Care Act is already spurring a public backlash, and why that backlash is only going to grow.

In this report, the CBO examined the “Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015,” which still forms the basis of the repeal effort. It covers what Republicans would be able to do under budget reconciliation, which only requires 50 votes in the Senate. The hitch, though, is that reconciliation bills can include only provisions that directly affect the budget. In this case that excludes parts of the ACA like the ban on insurers rejecting patients with preexisting conditions, since that doesn’t have a direct budgetary impact. So this isn’t an evaluation of the effects of everything Republicans want to do, but only of the first step in their repeal effort, the most significant parts of which are the repeal of the individual mandate, the end of subsidies to buy insurance, and the rollback of the expansion of Medicaid.

So how dramatic is the carnage? Here’s what repeal through reconciliation would produce:

  • “The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026.”
  • “Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law—in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.”
  • “About half of the nation’s population lives in areas that would have no insurer participating in the nongroup market in the first year after the repeal of the marketplace subsidies took effect, and that share would continue to increase, extending to about three-quarters of the population by 2026.”

That doesn’t sound very appealing, does it?

Republicans will naturally protest that this doesn’t cover their glorious replacement plan, the details of which remain muddy . . . But this information is still important to know, because Republicans are essentially going to drop a nuclear bomb on the American health-care system, then build something on top of the rubble. If we’re going to evaluate what’s left at the end, we need to know how much destruction they’re causing in the first place.

So for instance, if their combination of tax credits and health savings accounts gets an extra 5 million people covered, but they’ve eliminated coverage for 32 million, they’d still have eliminated coverage for 27 million. I might be low-balling there by tossing out the number 5 million; we’ll have to wait until they release an actual plan that can be evaluated to get a better idea. But not even Republicans themselves are going to claim that their plan’s magical market-based mystery mojo is going to get another 20 million or 30 million people insured. That’s because covering as many people as possible isn’t their goal and never has been [despite Trump’s recent assertion of “insurance for everybody”]. It’s why they’re careful to say they’re promoting not universal coverage but “universal access,” which is universal in the same way that access to BMWs is universal: Anyone can buy one, if they have the money.

Republicans are now confronting the fact that when you have complete control of the government and you proudly announce that you’re about to do something that causes huge amounts of human suffering, people take notice. Which is why a backlash to the Republicans’ plan to undo the ACA is brewing, not just among partisan Democrats hoping to preserve Barack Obama’s achievement and score a victory against Republicans but also among people who are terrified of losing the security the ACA has given them.

All along, Democrats have been saying the following: Yes, the ACA has some problems, but it has also done a tremendous amount of good. So why don’t we just figure out what isn’t working, and fix those things? Republicans responded with an emphatic “NO!” They insisted that they would accept only total repeal, no matter how much destruction it caused. Well now everyone’s getting a better idea of the magnitude of that destruction. No wonder they’d rather we didn’t talk about it.

Finally, I think that Paul Waldman overstates his case that Trump’s promise of “insurance for everyone” (universal coverage) may have just destroyed the Republican effort to repeal Obamacare. Trump will just do what he always does, deny he ever said it, and a feckless media will let him get away with it.


  1. Yes, it will be a calamity for some people if the GOP cancels the ACA. Those who didn’t have insurance before the ACA because it was so expensive will likely not have insurance after the ACA is cancelled because they won’t be receiving those big subsidies they were receiving under the ACA.

    However, those people who found themselves unable to afford insurance once the ACA kicked in and they were declared “rich” by some formula the ACA established will very likely be able to afford it again.

    And others, who choose not to purchase insurance because they are young and healthy will not have to pay those ridiculous penalties called for in the ACA.

    Just as there were winners and losers when the ACA kicked in, there will be winners and losers when the ACA gets kicked out. Just because some people had a windfall when the ACA kicked in doesn’t mean it was a guarantee for life. Cancelling the ACA just shifts the “winners and losers” lottery around a bit.

    • We wouldn’t be struggling with this if people believed that a reasonable level of healthcare for everyone is a right and not a privilege.

      I was thinking about this yesterday. My father was 47 years old when I was born and he only lived for another 10 years. He had some form of heart disease as well as atherosclerosis. I really don’t know much about what was wrong with him. His issues were apparently partly hereditary and partly due to his wild, misspent youth and the southern food he liked so much. He also smoked like a furnace.

      I do remember that he went to see his doctor on a regular basis and he was told to stop smoking and eat a healthier diet. But back in those days, there just wasn’t anything out there like the heart surgeries and medications available now.

      Back then, there would not have been such a wide gap between those with access to healthcare and those without. In my father’s case, it would have been unnoticeable. Either way, he would have died on the same day.

      In the decades since, obviously, all of that has changed. The gap between those with access to affordable healthcare and those without is extremely wide. For many, it’s life and death. Or it can also mean living with pain and debilitating illness and injuries. We all know it means for those who do not have access to healthcare when they need it, so there is no need to go further into this.

      It’s really a moral question. Do our politicians, who we elect, get to decide who lives and who dies? Because, when all is said and done, that is what we are talking about.

      I am not content to think of this in terms of “winners and losers.” If I agree to that, then I agree that my “representatives” (ha ha) shall decide who these people are, who wins, who loses, who lives, who dies, who goes bankrupt, who lives with pain, who gets diagnosed and treated, who gets medicine, and so forth.

      That is not a good system. And it will not work in the 21st century, the age of the “social”. People aren’t going back to 1930, they are not going to accept it from these Republicans who want to destroy the social safety net so their benefactors don’t have to pay taxes. Furthermore, it is WRONG.

      • “We wouldn’t be struggling with this if people believed that a reasonable level of healthcare for everyone is a right and not a privilege.”/i

        What constitutes a “reasonable level of healthcare”, Liza? I would postulate there is no such thing. If your child was sick, would you settle for a “reasonable level of healthcare” to take care of them? What if it wasn’t enough to cure them? What then?

        You have, though, hit the nail on the head when it comes to health care. It is staggeringly expensive. It is currently 1/7th of our entire economy at a cost of 100’s of billions of dollars. With the ACA it is expected to become even a greater part of our economy at even more billions of dollars. How much of a burden is too much to expect a nation to bear? Healthcare is very complicated and horrendously expensive…when does the time arrive when we can’t afford it? Who loses their health care when the bank goes dry?

        Other nations providing universal healthcare face these questions all the time because NONE of them have been able to completely fund healthcare in their nations. At the end of the fiscal year, many medical procedures are postponed until the following fiscal year because there is no money left to perform operations and procedures. Who is going to sit on the selection committees to decide who gets the needed procedure and who is allowed to die? It is not a theory that it might happen, it is happening right now.

        • > Who is going to sit on the selection committees to decide who gets the needed procedure and who is allowed to die? It is not a theory that it might happen, it is happening right now.

          Would you rather the selection committee be chosen by the government, which is at least in theory accountable to the people via the Democratic process, or by insurance adjusters and executives, who are only accountable to shareholders in the pursuit of profit maximization? At this point, those are our options. Either we decide that healthcare should be provided socially, or we leave it to the whims of the market and the profit motive. Those are our options.

          I am not sure I like the idea that the Bill Gates’s and Betsy DeVos’s of the world can buy longer lifespans that people in poverty don’t have access to. But answering questions such as this is, at its core, what politics and public choice theory is all about.

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