Affordable Care Act Repealed – What it Could Mean to You

It is an election year with lots of ideas being tossed around for how to reform our health care system.  One of the ideas is to repeal the Affordable Care Act (ACA a.k.a. Obamacare) and start new.  I preface this post with I am here to present the facts with a non-partisan approach. My end goal is to provide the facts so consumers are informed to make smart choices for health care and also be an informed voter.

While it is true, the ACA did not fix everything; it was the first significant change to our health care system since 1965. Medicare was established July 30, 1965 by President Lyndon B. Johnson. The ACA took effect March 30, 2010, by President Barack Obama.  The implementation of ACA was the most significant change in health care since Medicare, and it took forty-five years to complete.

The ACA has brought many benefits to our health care system to include:

Advantages

• Domestic Partners allowed to be covered
• Pre-existing conditions
• Enacting requirements for insurance companies
  

Disadvantages

• Lack of choice in plans
• Higher premiums
• Requirement for individuals to have insurance or pay a penalty.

What are the Impacts if ACA is Repealed?

• Loss of insurance – 21 million (M) people could lose their insurance. 11.4M who purchased insurance through a marketplace, 12M who receive Medicaid benefits through the expansion of Medicaid coverage. Also impacted are 9.2M who receive federal subsidies. Approximately $525 was covered of a $612 monthly premium.According to statistics from the Department of Health and Human Services.
• Medicaid impacts–Medicaid helps support individuals and children who have a low income and or limited resources. Review the statistics by Medicaid and CHIP Payment and Access Commission (MacPac)  noted by the state to understand the impact of how 12 M could potentially lose access.
  • Losing access would mean worse access to care and more trips to the ER resulting in higher cost.  Medicaid has improved access to preventative care, mental health and medications according to Kaiser Family Foundation (KFF).
• Opioid Crisis–Since ACA has taken effect, the opioid epidemic has been spreading. Current statistics show that $874M Medicaid spending for opioid addiction has doubled.
  • The ACA requires insurance companies to cover substance abuse and treatment.  If this were to stop, opioid misuse would likely increase.
  •  Due to the uninsured population, many states have established providers who treat opioid addiction, created methadone clinics, in patient programs ad primary care physicians supporting management and care of addiction.
• Pre-existing conditions–approximately half the populations under the age of 65 or 133M Americans have a pre-existing condition.  Repeal of ACA would disqualify them from purchasing health insurance or require a significantly higher monthly premium for care.
  • The ACA protects Americans from denied coverage or having their policies cancelled. It is estimatedthat 52M people have conditions serious enough that insurance companies may deny them coverage if the ACA is not active.  Reference: Kaiser Family Foundation: Analysis Pre-existing Conditions.
  • While some employer plans would still cover, those seeking to start a business or retire early would be most impacted.
• Insurance CAPS – 171M could be impacted by caps for expensive treatments. The ACA requires that insurance plans (grandfather plans excluded) must have a cap on a subscriber’s out-of-pocket expenses.  Prior to this, individuals with cancer or hemophilia often went bankrupt paying for expensive out-of-pocket costs until they reached a less favorable cap or worse case going without treatment.
• Medicare beneficiaries – 60M could be impacted by changes and or higher premiums. While ACA was targetedto make a significant change in health care mainly with the insurance markets, the mandates have an impact onMedicare.  A full analysis by the Kaiser Family Foundation, implications repealing ACA, which discusses the details of how disruptive this could be for patients 65 years or older or those with disabilities.
  • Paying for preventative care, a diabetes or blood pressure check or wellness visit now free could require payment.
  • More dollars spent on their prescription drugs which are already expensive with the projection of dollar spend to continue on an upward spend.

• Young adults no longer covered – 2M impacted young adults could be required to get their own insurance plans if employers choose to not honor the ACA mandate.  The ACA extended the time a dependent child could be covered under a parent’s plans until the age of 26.
• Uninsured 50 billion spend on medical care for the uninsured could rise. As individuals lose insurance, physicians and hospitals lose this revenue.  Also, those who are uninsured could go without care, resulting in treatment for care at later stages that may be terminal and or more costly to treat.  The uninsured may be more dependent on hospital and ER care, which are higher costs options contributing to the $50B spend.

For more detailed information reference: The NYTimes, What Happens if ObamaCare is Struck Down?

In closing, the other impact, I would mention, is the administrative costs that are associated with a new health care change repealed or implemented.  The administrative burden of loading a pharmacy benefit system, claims and benefit systems add administrative costs to insurance companies that can impact higher premiums to you.

Repealing ACA has significant impacts especially considering it is the first significant change in 45 years. Perhaps identifying what is working with ACA and what is not is a more sensible and less disruptive approach to best support health care for all. You decide.

Refer to Savvy Health Care Consumer Health Health Care Reform, where I have placed links and articles to the latest proposed plans per candidate.  Be a Savvy Health Care Consumer voter.