As Republicans in Congress gear up for a quick repeal of the Affordable Care Act, a chorus of local activists have ramped up their objections.
This week, President-elect Donald Trump put out several Twitter comments on the Affordable Care Act, including a reference to the 116-percent increase in unsubsidized premiums in Arizona on the health insurance marketplace exchange. Gila County is one of many in the state this year with only one insurance company offering health plans on the federal exchange.
Trump Tweeted, “The Democrats, lead by head clown (Senator) Chuck Schumer, know how bad ObamaCare is and what a mess they are in.”
Meanwhile, House and Senate Republicans have reportedly developed a plan to repeal most of the provisions of the Affordable Care Act through a complicated maneuver directing two budget committees to cut $1 billion from the deficit. This would theoretically prevent Democrats from blocking a repeal through a filibuster. Ironically, independent estimates suggest the repeal of the health care reforms would actually increase the federal deficit by about $35 billion annually.
Advocates for the health care law in Arizona quickly shot back.
DJ Quinlan, Arizona spokesman for Arizona’s Alliance on Healthcare Security, released a statement saying, “Of the Arizonans who do buy their insurance on the marketplace, 78 percent of them will be able to get 2017 ACA coverage for $100/month or less after tax credits. As premiums rise, so do the tax credits that help people afford coverage. The real problem we face is that Trump’s plan to repeal the Affordable Care Act will put a Grand Canyon-sized hole in our state’s health care system.”
The group released statistics on the effect a full repeal of the Affordable Care Act would have in Arizona:
709,000 Arizonans would lose health coverage, doubling the number of people without medical insurance. [Urban Institute]
124,346 Arizonans would lose an average monthly advanced premium tax credit of $230. [Kaiser Family Foundation]
Arizonans would lose $10 billion in federal financial assistance through the insurance marketplace from 2019-2028. [Urban Institute]
Arizona would lose $32 billion in federal Medicaid or Children’s Health Insurance Program (CHIP) funding, currently covering 1.7 million Arizonans. [Urban Institute, Kaiser Family Foundation]
Nationally, the Affordable Care Act has provided coverage for 20 to 30 million Americans. In the process, the Act cut the number of people without insurance from about 42 million to 28 million. That includes a federally funded expansion of Medicaid programs like the Arizona Health Care Cost Containment System (AHCCCS).
Trump has promised to “repeal and replace” ObamaCare with a better, less expensive plan. However, the nature of the replacement plan remains unclear. He has said he wanted to keep a provision that requires health insurance plans to include coverage for people with pre-existing conditions. But it’s unclear how to keep that provision, while getting rid of the premium subsidies based on income, various taxes and fees that supported the program and fines for people who decide not to buy insurance.
The Kaiser Family Foundation estimates that eliminating that provision could ultimately cost 52 million Americans coverage in the future — a far larger group than the Affordable Care Act covered.
A full repeal could also affect Medicare coverage for people older than 65. One of the provisions of the act closed the so-called “donut hole” in coverage of prescription drugs on Medicare, which resulted in big savings for many people on Medicare.
A repeal could also boost the federal budget deficit by $353 billion over 10 years according to the Congressional Budget Office. The act imposed some additional taxes for people making more than $200,000 annually and also included fees on health plans, medical-device companies and drug makers.
People who lost coverage through the Marketplace plans would likely spend an additional $1,500 annually if they sought other coverage, according to estimates in a study by the Commonwealth Fund and the Rand Corporation.
It’s unclear whether House and Senate Republicans plan to repeal the Affordable Care Act immediately, then work on providing an alternative later. So far they’ve worked out a strategy to foil a filibuster or other delaying tactics, but haven’t settled on what provisions to keep and which ones to drop, according to news accounts.
Discussions of a possible alternative plan include ideas like state-run “high risk pools” for people with pre-existing conditions, allowing the sale of medical insurance plans across state lines and encouraging small businesses to band together to buy insurance through “association health plans.”