Senate Republican leaders say they’ll move immediately to start repealing the Affordable Care Act, often known as Obamacare, next month. But they don’t yet have a clear plan to replace the 2010 law the Obama administration billed as “comprehensive health insurance reforms that put consumers back in charge of their health care.”
President-elect Donald Trump promised repeatedly during his campaign to repeal and replace the ACA, and lays out a plan on his transition website that would replace it with a solution that includes health savings accounts. He says his administration’s goal will be “to create a patient-centered health care system that provides choice, quality and affordability with health insurance and health care.” He nominated Rep. Tom Price (R-Ga.), a fierce opponent of the ACA, as head of the Department of Health and Human Services late last month.
“He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare, and will bring affordable and accessible health care to every American,” Trump said.
On Tuesday, Republicans signaled that they are moving ahead, quickly, to fulfill the president-elect’s promise.
“The Obamacare repeal resolution will be the first item up in the new year,” Senate Majority Leader Mitch McConnell (R-Ky.) told the New York Times. But he admitted to CNN that there would be challenges in getting that done.
“This has been a very, very controversial law,” McConnell said. “We have an obligation to the American people to change it and do a better job. If we could get Democratic cooperation in doing that, that would be great.”
The strategy would involve beginning the repeal process in early January, but it might defer the effective date for years. Republican leaders say the replacement may involve giving states the primary responsibility for health policy rather than the federal government; putting patients and doctors in control; more competition among health plans; and giving small businesses more flexibility in putting together health benefits for their employees.
Some Republicans discussed the need to both repeal and replace the law, which might minimize the drama of transition for the 20 million people who have gained coverage under the ACA.
“They have to be done together," said Sen. John McCain (R-Ariz.). “We don’t want to have people left out.”
Incoming Senate Minority Leader Chuck Schumer (D-N.Y.) is vowing a fight, telling the Times, “Just repealing Obamacare, even though they have nothing to put in its place, and saying they’ll do it sometime down the road, will cause huge calamity from one end of America to the other.”
On Wednesday the nonpartisan, Washington, D.C.-based Urban Institute released a report warning of dire consequences if Republicans were to move forward with a bill similar to the one vetoed by President Barack Obama in January.
The report predicts “significant market disruption” if the ACA is partially repealed amid an already established plan year. It says that some people will stop paying premiums, and insurance companies could suffer $3 billion in financial losses. The Urban Institute calculates that the number of uninsured people could rise to 58.7 million in 2019, and the share of uninsured nonelderly people could rise to 21 percent, higher than the uninsured rate before the ACA.
It also finds that 12 percent of the people becoming uninsured would be African American, 22 percent would be Hispanic, 7 percent would be Asian, and 2 percent would be American Indians or Alaska natives. In addition, the nonprofit, California-based Kaiser Family Foundation finds that the ACA has been a boon for many people of color in their quest for health insurance.
Kaiser released a statement Nov. 4 that its report found that not only has the uninsured rate fallen among all racial and ethnic groups under the ACA, but it fell more quickly among people of color between 2013 and 2015. It dropped 9 percentage points among Hispanics, 5 percentage points for blacks and 7 percentage points for Asians. Still, more people of color than whites were likely to be uninsured in 2015.
“Continued outreach and enrollment efforts may lead to continued coverage gains and further reduce coverage disparities,” the report’s executive summary concludes.
Pro-choice organizations such as Planned Parenthood are concerned about what a repeal of ACA would mean for women in general, and for women of color in particular. In a fact sheet, it says that 55 million women would lose access to no-copay preventive services such as birth control, along with screenings for sexually transmitted infections and breast cancer. Planned Parenthood says that the ACA has had a huge impact on millions of people, particularly people of color, who often face systemic barriers to health care.
“If the ACA is gutted, it’s going to hurt women broadly,” Planned Parenthood’s Alencia Johnson told The Root. “The ACA has been a big piece in closing the gap of disparities for black and brown folks because more people are being insured. The preventive care … is critical for black women, as we are more likely to die from breast cancer, and their infant mortality rate is … higher than non-Hispanic white women.”
But while the Republicans figure out their plan, premiums under ACA will jump an average of 25 percent across 39 states. On top of that, the number of insurers in the federal marketplace will drop from 232 this year to 167. This could be challenging for people of color, who are often more at risk for chronic conditions such as high blood pressure and diabetes, and others who may need to switch their insurers, doctors and medication.
Still, House Speaker Paul Ryan (R-Wis.) says that no one will be “worse off” after lawmakers vote to repeal the Affordable Care Act.
“Obamacare is failing and failing quickly. There is nowhere to go but up with respect to Obamacare,” Ryan told the Milwaukee Journal Sentinel. But he stressed that working out a deal on the details would take some time and thought, once the early repeal vote happens next year: “Clearly there will be a transition and a bridge so that no one is left out in the cold. … The purpose here is to bring relief to people who are suffering from Obamacare so that they can get something better.”
Allison Keyes is an award-winning correspondent, host and author. She can be heard on CBS Radio News, among other outlets. Keyes, a former national desk reporter for NPR, has written extensively on race, culture, politics and the arts. Follow her on Twitter.