The Affordable Care Act Repeal Impacts You

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By: Amber Christ, Esq.

So much has happened in the last month with health care that it's hard to keep up. Here's a quick rundown of what's going on, who is impacted, and what you can do.

Repeal Efforts
Republicans are quickly moving forward to repeal the Affordable Care Act (ACA) -- aka Obamacare. They do not have enough votes to fully repeal the ACA without Democrats, so instead they are moving forward with a partial repeal through a special process called budget reconciliation. Through this process, with a simple majority, Republicans can only repeal components of the ACA that have a budget impact.

Right now, House and Senate committees are drafting a budget reconciliation package that will likely repeal significant portions of the ACA. The three main targets for repeal are 1. the tax subsides that people receive to buy insurance through the state exchanges or marketplaces; 2. Medicaid expansion in the 31 states that expanded Medicaid; and 3. the mandate that requires everyone to buy health insurance. Committees were supposed to submit their recommendations for budget cuts by January 27th. This date, however, was extended to late March or early April because of ongoing efforts to delay repeal until a replacement plan is ready to go.

Who is Impacted By Repeal -- Everyone
In total, 18 million people would lose insurance in the first year after a repeal, and everyone, regardless of coverage type, would be impacted.

1. Marketplace enrollees. 9.3 million individuals with low to moderate incomes (up to $47,080 for an individual) would lose their tax subsidies to buy health insurance on the marketplace exchanges, and marketplace insurance premiums would increase by 20-25% in the first year after repeal. Many others would also lose cost-sharing assistance that lower out-of-pocket expenses and deductibles.

2. Medicaid expansion enrollees. In the 31 states that expanded Medicaid, 12.9 million low-income individuals (with incomes up to $16,394) would lose coverage. These are individuals who work -- usually in full-time jobs that pay minimum wage or just above -- but the employer does not offer affordable health insurance coverage.

3. Employer-based coverage. Employer-based plans cover 150 million people. If the ACA is repealed, out-of-pocket costs would rise and other protections would go away. Right now, there are no co-pays for preventive services like mammograms, colonoscopies, immunizations, and birth control. The ACA also capped the amount you have to pay annually in out-of-pocket expenses at $7150 for an individual and did away with annual and lifetime limits on coverage. The ACA also allows kids to stay on their parents' employer coverage until they are 26. All of this is eliminated if the ACA is repealed.

4. Medicare enrollees. Under the ACA, Medicare provides preventive services for free and makes prescription drugs more affordable. If the ACA were repealed, Medicare enrollees would see higher medical and prescription drug costs. In addition, some replacement plans for the ACA propose privatizing Medicare, which would provide less coverage at a higher cost for Medicare enrollees.

5. Pre-Existing conditions . If you have a pre-existing condition you would have to pay more. Over 52 million people under 65 have a pre-existing condition. Currently, the ACA provides health insurance at the same cost for healthy and unhealthy individuals. This is a popular part of the ACA and one that everyone thinks should stay. Yet, that becomes really hard if the individual mandate is repealed.

The ACA creates one risk pool of both healthy and unhealthy individuals. The healthy individuals subsidize the cost for the unhealthy individuals. If there is no health insurance mandate, healthy people are far less likely to buy health insurance, or would wait to buy insurance until they get sick. If plans have to keep covering people with pre-existing conditions, they would have to raise premiums -- making health insurance far more expensive. An alternative that has been proposed is to create two risk pools -- one for healthy individuals and one for the unhealthy individuals. The risk pool for the unhealthy population would cost more and have higher deductibles. These "high risk pools" have been tried before and have proven unsuccessful. Either way, without a mandate, health insurance rates would increase.

6. Women and older adults. Women and older adults would pay more. Prior to the ACA, health insurance plans could charge women more for their coverage on the basis that women use more health care than men. The ACA now prohibits health plans from charging women more for coverage. Similarly, prior to the ACA, older adults could be charged up to five times more than a younger individual for coverage. Under the ACA, older adults can only be charged three times more than a younger individual.

7. Medicaid for children, aged, and disabled. Children and adults living in poverty would suffer. The Medicaid program has been providing health care coverage to those living in poverty for over fifty years. In the last few days, Republicans have indicated that with the ACA repeal they also plan on cutting federal funding for the Medicaid program through cap proposals (aka block grants or per capita allotments). These proposals would cut federal funding of the Medicaid program by one trillion dollars over ten years. States would be forced to make difficult choices about which populations they would cover (older adults versus children, for example) and what benefits to provide.

8. Your tax bill. The very wealthiest 400 households would receive huge tax cuts, while most of us would see no change and some of us would even see tax increases. The ACA was able to provide health insurance coverage so broadly in part because of taxes on individuals with higher incomes. When the ACA is repealed, the highest income households (those with incomes over 300 million) would see an annual tax cut of 7 million. Those households with incomes below $200,000 would see NO tax cut (about 150 million households). Finally, those households with incomes $47,080 or below (those households that received the tax subsidy to buy health care), would see their taxes increase on average by $4800.

Get Involved
Regardless of your feelings about the ACA and political affiliation, a repeal without a comprehensive replacement would be catastrophic. In fact, the majority of individuals who have purchased insurance through the state marketplaces live in Republican congressional districts. To date, Republicans have not put forth a plan that would replace the ACA or a plan that would serve to improve the ACA, and past proposed plans do not include provisions that would address the issues outlined above. So get involved.

1. Call or write your congress members. The most effective way to get your congress member's attention is through a phone call. Writing your congress member is also effective. Here's how:
US Senate:
US House of Representatives:

2. Get involved in your state's coalition. Many states have coalitions of organizations, advocates, and individuals working collectively to protect health care. These coalitions may be statewide or more local. Nationally, the Protect Our Care coalition can help get you connected with state-based coalitions.

3. Share your story. Share your story of how the ACA has benefited you and how a repeal would impact you. There are many national, state, and local advocacy organizations collecting stories. You can also share your story online under hashtags like #CoverageMatters and #ProtectOurHealth.

Amber Christ is a national health care policy attorney based in California. This article was previously published on Medium on January 23, 2017. Edits were made to article on January 30, 2017, to reflect updates on the status of the repeal that were announced on January 27, 2017.

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