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; a spokesman for House Speaker Paul D. Ryan said this morning that the CBO report is meaningless because it doesn’t assess their as-yet-undetermined replacement. 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. 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.