Ever since last year's election results became known, the congressional majority has labored to repeal and replace the Affordable Care Act, a.k.a. Obamacare, President Obama's signature legislation which went into effect in January of 2010. Aside from attempting to fulfill a political promise seven years in the making, the most significant reasons behind the desire to repeal the law have been "government overreach," budget impact, and the additional taxes levied on high income earners. Moreover, legislators want to use the potential savings realized from repeal to fund another policy objective, tax reform.
Obamacare's major accomplishment was that it pushed the nation's health insurance uninsured rate to a record low 8.6 percent, composed of about 27.3 million people. Those numbers were 16 percent and 48.6 million in 2010. The law helped provide insurance for an additional 21.3 million people. This result was achieved by mandating that nearly all Americans have some form of health insurance or pay a tax penalty, barring insurance companies from declining coverage to people with pre-existing conditions, and authorizing an expansion of Medicaid to nearly all poor adults. (Thirty-one states expanded Medicaid programs with the federal government picking up most of the costs of providing coverage to the newly eligible.)
The most recent analysis by the Congressional Budget Office (CBO), which focused on the current proposal considered by the Senate, to "repeal without replacement," estimates that, when enacted, this legislation would increase the number of uninsured by 17 million in 2018, and 32 million by 2026. The CBO estimate also projected that insurance premiums in the individual market would double, and it suggested that by 2026 most of the country would no longer have an insurer selling individual plans. Its projections assumed that a total repeal would include the end of mandatory insurance requirements, an end to subsidies to help low- and middle-income people purchase individual plans, and, by 2020, the end of federal funding for the expansion of Medicaid to poor adults. It would decrease federal deficits. Most of the savings would be generated by repealing the Medicaid expansion. ("H.R. 1628, Obamacare Repeal Reconciliation Act of 2017," CBO, July 19, 2017.)
While many of the proposed policy nuances may appear convoluted and unnecessarily complex, the elements affecting our personal lives are simple: 1. How will policy changes affect our premiums? 2. How many more of us will end up uninsured? 3. What effect will this condition have on our lives, individually, cumulatively, and on the viability of our support network?
Simply put, the uninsured have very limited access to healthcare Their care will generally come too late. They will be sicker and die sooner One in five uninsured adults will go entirely without medical care due to cost. They won't receive preventive care and services for major health conditions and chronic diseases. ("Key Facts about the Uninsured Population," Kaiser Foundation.)
A 2003 study published by the National Academic Press, entitled "Social and Economic Costs of Uninsurance in Context," provides even greater detail. Its findings show that 18,000 will die prematurely, 8 million uninsured with chronic illnesses will receive fewer services and have increased morbidity, 41 million adults and children will be less likely to receive preventive and screening services, and people living in communities with higher than average uninsured rates will be at risk for reduced availability of health service and overtaxed resources.
Other analyses of Obamacare repeal suggest that repeal of tax credits and Medicaid expansion could lead to a loss of 2.6 million jobs in 2019, and cuts in federal spending for health reform would likely cause serious economic distress for states. "If replacement policies are not in place, there will be a cumulative $1.5 trillion loss in gross state products, and $2.6 trillion reduction in business output from 2019 thru 2023. ("Repealing Federal Health Reform: Economic and Employment Consequences for States." This study was financed by the Commonwealth Fund.)
We should also consider the plight of hospitals. The "Emergency Medical Treatment and Labor Act," passed in 1985, requires that hospitals treat all individuals in need of emergency care regardless of their insurance status. When people are uninsured hospitals effectively serve as insurers of last resort by providing care to uninsured patients who cannot afford to pay for their medical bills. The estimate is that each additional uninsured person costs local hospitals $900 per year. In 2013 alone the cost of uncompensated care was $84 billion. ("Who bears the cost of the uninsured? Non-profit hospitals." Kellog Insight, North-Western University, June 22, 2015.)
This all boils down to a question of priorities. How important is it to us, as a society, to protect those who can least afford it? Do we really think that politically flaunting "access" to health care equates with actually making care available and affordable for all? Shouldn't we consider the consequences simplistic political calculations impose on our personal lives and on the deteriorating health care support structures surrounding us? Do we really want our representatives to ignore these consequences because they promised they would repeal a law that has been on the books for seven-plus years, or because they need to realize a savings so they can squander it on tax reductions for some who don't need it?
The answer appears obvious. This can't just be about economics and politics, this is a moral issue as well.
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