U.S. Senate Republicans couldn’t find the 51 votes needed this week to pass its bill to cut Medicaid and repeal the Affordable Care Act. Within the GOP caucus, members couldn’t reach consensus on some of the most damaging parts of the bill: huge cuts to Medicaid (Texas would lose $1.5 billion in federal funds each year) and gutting protections for people with pre-existing conditions.
As a fallback, Senator Mitch McConnell has pledged to have a vote on a bill to repeal the ACA with no replacement plan. That vote could happen as early as this week, if enough Senators vote to start debate, which looks unlikely right now. This ridiculous strategy – asking Americans to just trust that Congress will come up with a great ACA replacement plan later, when they haven’t done so over the last 7 months – will jeopardize coverage for 32 million Americans. It is reckless. That is why GOP members of Congress and President Trump rejected this exact strategy earlier this year.
Here’s a quick refresher on the real and immediate harm of repeal-and-figure-something-out-later:
- The bill will immediately end the “individual mandate,” which encourages healthier people to get coverage. It also ends Marketplace subsidies that help people with modest incomes pay for coverage with no replacement. But the bill doesn’t (and can’t through the reconciliation process) end the requirement that insurance companies accept sick enrollees and charge them the same premiums as everyone else. This dynamic will quickly destabilize the individual insurance market, causing a “death spiral” as sick people cling to their coverage and healthy people drop it.
- In Texas, 1.8 million people rely on coverage through the individual market. They don’t get coverage through work, Medicaid, or Medicare; they buy it directly on their own. Roughly half get subsidies through the Health Insurance Marketplace (that are ended under the bill) and half buy at full cost. Coverage for all 1.8 million will be at risk, as this market essentially collapses.
- The Congressional Budget Office projects that individual market premiums will skyrocket- climbing 20-25 percent in the first year and doubling over a decade. Also, more and more insurers will leave the market. By 2020, half of Americans will live in an area where individual market coverage simply isn’t offered at all, and that share will grow to 75 percent of Americans by 2026.
- The Urban Institute estimates that by 2019, 2.6 million Texans would lose their insurance coverage – including everyone in the individual market along with additional coverage losses through job-based insurance and Medicaid/CHIP.
- The bill will immediately end all ACA-related taxes, giving huge tax cuts to wealthy people, drug manufacturers, and insurance companies.
Repeal and delay is reckless and irresponsible, and it is certainly not the health care reform Americans are calling for. A large majority of Americans – 71 percent – want Congress to work together to fix problems with the ACA and improve it. Congress should get to work on real health care reforms that will stabilize the individual insurance markets and make coverage more affordable to more people.