So what would happen if we repealed ObamaCare?


The recent action by the Republicans in the Senate to repeal ObamaCare through the procedural vehicle of reconciliation appears to be delayed. The passage by the House of numerous repeal bills has allowed Republicans to achieve a campaign promise from virtually every campaign since 2010.

Maybe the president should sign one of these bills. Let’s see what would happen.

The Senate legislation repeals the mandate for individuals to buy health insurance and for employers with more than 50 workers to provide it; it eliminates all fines for people and companies that failed to comply with the mandates; and it would eliminate federal subsidies to about 6 million low- and moderate-income Americans who buy their own insurance, as well as roll back ObamaCare’s expansion of Medicaid for the poor, which has been adopted by more than 30 states. There is evidence that 17.6 million people in the United States have gained medical insurance coverage as a result of ObamaCare. As well, ObamaCare eliminated insurance companies’ ability to exclude those with pre-existing conditions and has kept children on their parents’ insurance until age 26.

{mosads}In contrast, Senate Majority Leader Mitch McConnell (R-Ky.) relies on non-verifiable falsehoods (this term originated with Philip E. Tetlock and J. Peter Scoblic) by stating that ObamaCare has raised healthcare costs, limited patients’ ability to choose their doctors, hurt the already struggling middle class and negatively impacted millions. Do you notice something there? There are no specifics — just generalities that can neither be proved nor disproved. These are themes regurgitated by Republicans ad nauseum since 2010. You will also note that the legislation does not contain any substitute or any attempt to modify the legislation to make it better.

If you remove tens of millions of people from the rolls of the insurance carriers because subsidies are eliminated and Medicaid expansion is defunded, if young adults ages 18 to 26 lose coverage, as well as those with pre-existing conditions, where do those who lose coverage go for care? As you might have guessed, it is your local hospital emergency room. This will result in tens of billions of dollars in uncompensated care being provided by our hospitals. Prior to the enactment of ObamaCare, uncompensated care provided by hospitals in our communities was in the range of $75 billion to $125 billion.

Would physicians continue to treat people who they knew had no coverage and no likelihood of being able to pay? That is another source contributing to the emergency room flood.

Then there is also the loss of revenue to insurance companies. (I am sure they will be happy with the repeal of the law, as well!) Premiums will increase as the result of fewer covered lives and the hospitals will press for higher reimbursements to recover uncompensated care losses. If we look back in the 10 years prior to the enactment of ObamaCare, health insurance premiums were rising at an astronomical rate, usually by double digits.

McConnell has offered no facts about rising premiums from 2000 to 2010, versus 2010 to the current date. As for the claim that people are not able to select their doctors, I haven’t seen it. Nothing’s changed, as insurance companies impacted that process well before ObamaCare with their in-network and out-of-network coverage structures and limitations on the use of specialists.

So why am I supporting repeal? I am not, really, but I do think it is worth pointing out what the impact would be. I am sure that insurance companies and those with insurance, as well as state governments, are not raising a huge cry because they don’t believe the president would sign any repeal legislation. But what if he indicated he might? What, then, would the reactions be? I suspect you would hear a loud cry, at least saying that if you are going to repeal it, you had better replace it, and you had better have a transition process in place. Otherwise, like McConnell said of the attempt to defund Parent Parenthood, “It’s an exercise in futility.”

As a member of Congress, I did vote in favor of the Affordable Care Act, but I said from the very beginning, it was going to need modification and adjustment. There has been little of substance placed on the table to improve ObamaCare other than the 1099 repeal early on, and now the medical device tax repeal and the postponement of the imposition of the “Cadillac tax.” These are merely window dressing and immaterial in terms of cost and impact. There are actions to be taken based upon advice provided by patient advocates, the insurance industry, nonpartisan think tanks and others. It is just not happening.

The chaos that would ensue in the healthcare system by repealing ObamaCare is largely unimaginable, and I suspect not at all thought through by proponents of repeal legislation.

Owens represented New York’s North Country from 2009 until retiring from the House in 2015. He is now a partner in the Plattsburgh, N.Y. firm of Stafford, Owens, Piller, Murnane, Kelleher & Trombley, PLLC.

Tags ACA Affordable Care Act Mitch McConnell ObamaCare
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