The new Senate strategy to repeal the Affordable Care Act without a replacement should be a “non-starter,” to use the words of Sen. Bill Cassidy earlier this month. The “repeal-only” approach would take health insurance away from more Americans and Louisianans than any of the replacement bills put forth by the House or Senate to date. Accordingly, repealing the Affordable Care Act without a simultaneous replacement has been criticized by a number of senators on both sides of the aisle and, at times, President Trump. A poll by the Kaiser Family Foundation in January 2017 found 75 percent of Americans either wanted Congress to leave the Affordable Care Act as is or repeal it only when they have a replacement bill in place.
The Congressional Budget Office (CBO) found in the first year alone, the bill now being considered by the Senate would cause premiums to rise by 25 percent and an additional 18 million Americans would be uninsured. By 2026, the repeal-only plan would leave 32 million Americans without health insurance and premiums in the individual marketplace would double. The rising premiums and loss of federal subsidies would put coverage out of reach for many current marketplace enrollees; with far fewer people buying coverage, the marketplaces would be destabilized. By 2026, CBO estimates three-quarters of Americans would live in areas without any insurers participating in the individual market.
The impact of a “repeal only” bill would be particularly harmful in Louisiana because it would eliminate the state’s Medicaid expansion. In 2020, the state would be forced to end its expansion program that provides coverage to people who are struggling to make ends meet. Unlike the American Health Care Act and Better Care Reconciliation Act, under the “repeal only” plan states would not even have the option to continue the Medicaid expansion by replacing lost federal funding with state funds. As a result, nearly all of the 430,000 Louisianans who have enrolled in Medicaid expansion would be without health coverage on January 1, 2020.
Eighty-six percent of Louisianans who purchase insurance on the individual marketplace receive federal subsidies to reduce their net premiums. In 2017, Louisianians who enrolled in marketplace coverage receive an average advance premium tax credit of $435, which covers 79 percent of the total monthly premium for comprehensive coverage. Under a repeal-only plan, those subsidies would be eliminated, and the vast majority of those who lose subsidies would be left with unaffordable premiums and would become uninsured.
Between those who would lose Medicaid coverage and private health insurance, the Urban Institute estimates an additional 558,000 Louisianans would be uninsured in 2026. The loss of coverage not only would worsen health outcomes and reduce financial security among Louisiana families, but the dramatic rise in uninsured residents would drive up uncompensated care costs for the state. Louisiana is responsible for between 35 and 40 percent of the costs of care for the uninsured, compared to just 5 percent for those who have coverage through Medicaid expansion.
The “repeal-only” plan also jeopardizes the Louisiana economy and health care jobs across the state. According to the Urban Institute study, ACA repeal would decrease federal health care funding to states by $1.3 trillion over the next decade. Funding for Louisiana alone would decrease by $26.7 billion between 2019 and 2028. The decrease in federal funds would eliminate jobs across the state. A study by The George Washington University found that if the ACA is repealed Louisiana would lose 37,000 jobs by 2019, including 11,900 in the health-care sector. State and local tax revenues would decline by $640 million and the state would lose $39.1 billion in business output between 2019 and 2023.
Given the harmful impact the new Senate strategy would have on states, a group of bipartisan governors – including Gov. John Bel Edwards – said in a joint statement today, “The Senate should immediately reject efforts to ‘repeal’ the current system and replace sometime later. This could leave millions of Americans without coverage.” We will soon see if our senators heed the governors’ advice.