There is no going back if the ACA is repealed

There is no going back if the ACA is repealed
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Repealing the Affordable Care Act’s (ACA’s) individual mandate in the tax bill is being characterized by some Senators as a catalyst for Congress to replace the health law next year. It may be just the opposite, equivalent to crossing a bridge and burning it behind you.

The individual mandate, or shared responsibility provision, gives people a choice: buy affordable coverage if you can afford it or pay a tax. It encourages people to maintain continuous coverage rather than purchase it when they get sick.

It has contributed to an individual market that, prior to being undermined by the Trump administration, was growing in size and stability. It contributed to the lowest uninsured rate in American history.


Knocking out this incentive for coverage would make it more (and for some too) expensive to buy individual market coverage. The Congressional Budget Office (CBO) estimated that average premiums would increase by 10 percent, which translates into nearly $2,000 per year for a family of four.

The amount would be greater for older Americans and those that live in rural areas. This premium increase, coupled with less emphasis placed on getting coverage, would result in an estimated 13 million more uninsured Americans.

If the mandate repeal is signed into law with the tax bill, there is no turning back for three reasons.

First, to date, no expert has identified a policy as effective as the individual mandate. For example, CBO estimated that the American Health Care Act’s proposal to maintain continuous coverage would end up causing more people to lose than to gain coverage. And proposals that incentivize private insurance won’t help the 5 million Americans who will no longer get Medicaid coverage under the tax bill.

Second, even if such a policy existed, no funding would be easily found to pay for the coverage for lost under the GOP bill. Congress has yet to agree on funding for the bipartisan Children’s Health Insurance Program. The $318 billion needed to cover those uninsured because of the tax bill is 40 times higher than the $8 billion Congress has failed to find for low-income children’s coverage.

Third, no trust would be left to make the system work as it did before. Democrats would be unlikely to give up parts of the ACA to make the Republican-induced problems less bad.

Republicans themselves can’t agree on how to lower private insurance premiums. Ideas like reinsurance are opposed by conservatives as insurance company “bailouts.” Ideas like allowing insurers to charge more or drop benefits for people with pre-existing conditions are opposed by moderates.

The bipartisan Alexander-Murray bill would only get the system back to the pre-Trump baseline; it would do virtually nothing to limit the tax bill’s impact. Insurance companies, faced with this bleak outlook, are likely to abandon this market.

And Americans may not only give up on Congress but on the prospects for the private insurance system altogether, increasing the demand for ideas like Medicare for more people.

Senate Republican's tax bill would cause real harm to Americans’ health, resulting in more unpaid bills, skipped health care, and preventable deaths. And it would harm America’s health-care system, increasing its costs and gaps.

There is no subsequent Congressional action that could retroactively restore people’s health and financial security after it is lost. And there may be no subsequent Congressional agreement that even attempts to do so. There is only one choice for Senators who care about lowering premiums and maintaining coverage: get the individual mandate repeal out of the tax bill.

Jeanne Lambrew a a former deputy assistant to President Obama for Health Policy and currently is a Senior Fellow at The Century Foundation.