So What Happens Once The Republicans Implement Ryan's And Price's Plan To Kill The Affordable Care Act?

Yesterday we all read that life expectancy-- particularly for the American working class-- has dropped. And you can't even blame the NRA for all of it-- heart disease, stroke, cancer, diabetes, Alzheimer's, drug overdoses are all contributing, as Gaius went into more deeply this morning. And Trump, Pence and Tom Price haven't even been sworn in yet! In theory Trump and the congressional Republicans are in synch about repealing Obamacare. Trump campaigned on repealing it and replacing it with something fabulous. Congressional Republicans mostly just campaigned on repealing it, presenting it as a substitute and an abstract effigy for Barack Obama, focusing as much hatred as they could on it. So do the congressional Republicans have to come up with something fabulous to replace it with so that Trump doesn't look like a lying sack of shit? Or is that just another one that just get slipped down the collective memory hole?

When they repeal and not replace the Affordable Care Act-- or at least start the process by killing off the exchanges-- it will send the U.S. health care system into disarray and lead to 29.8 million people losing their coverage, something like 16.6 million of whom are white-- not just white, but white working class. I wonder how many of them voted for Trump.

According to a new study from the Urban Institute, 82% of those who would lose coverage are in working families. Repealing the Affordable Care Act without a replacement plan will more than double the number of uninsured children in the country-- leaving 4 million children uninsured.

  Dangerous plans to repeal the Affordable Care Act without replacing it are a serious threat to hospitals, providers, and caregivers-- jeopardizing lives, livelihoods, and communities across the country. Hospitals are already warning of an "unprecedented public health crisis." Providers, including hospitals and doctors, would see a dramatic surge in uncompensated or charity care, $88 billion in 2019 alone and $1.1 trillion from 2019-2028.

Murderous mission

Paul Ryan, Kevin McCarthy, Tom Price, Mitch McConnell and Lamar Alexander are plotting to repeal the ACA, at least partially, through Reconciliation. The Urban Institute analysis starts with the premise that "since only components of the law with federal budget implications can be changed through reconciliation, this approach would permit elimination of the Medicaid expansion, the federal financial assistance for Marketplace coverage (premium tax credits and cost-sharing reductions), and the individual and employer mandates; it would leave the insurance market reforms (including the nongroup market’s guaranteed issue, prohibition on preexisting condition exclusions, modified community rating, essential health benefit requirements, and actuarial value standards) in place." They compare future health care coverage and government health care spending under the ACA and under passage of a reconciliation bill similar to one vetoed in January 2016. The key effects of passage of the anticipated reconciliation bill are as follows:

• The number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people (103 percent). The share of nonelderly people without insurance would increase from 11 percent to 21 percent, a higher rate of uninsurance than before the ACA because of the disruption to the nongroup insurance market.
• Of the 29.8 million newly uninsured, 22.5 million people become uninsured as a result of eliminating the premium tax credits, the Medicaid expansion, and the individual mandate. The additional 7.3 million people become uninsured because of the near collapse of the nongroup insurance market.
• Eighty-two percent of the people becoming uninsured would be in working families, 38 percent would be ages 18 to 34, and 56 percent would be non-Hispanic whites. Eighty percent of adults becoming uninsured would not have college degrees.
• There would be 12.9 million fewer people with Medicaid or CHIP coverage in 2019.
• Approximately 9.3 million people who would have received tax credits for private nongroup health coverage in 2019 would no longer receive assistance.
• Federal government spending on health care for the nonelderly would be reduced by $109 billion in 2019 and by $1.3 trillion from 2019 to 2028 because the Medicaid expansion, premium tax credits, and cost-sharing assistance would be eliminated.
• State spending on Medicaid and CHIP would fall by $76 billion between 2019 and 2028. In addition, because of the larger number of uninsured, financial pressures on state and local governments and health care providers (hospitals, physicians, pharmaceutical manufacturers, etc.) would increase dramatically. This financial pressure would result from the newly uninsured seeking an additional $1.1 trillion in uncompensated care between 2019 and 2028.
• The 2016 reconciliation bill did not increase funding for uncompensated care beyond current levels. Unless different action is taken, the approach would place very large increases in demand for uncompensated care on state and local governments and providers. The increase in services sought by the uninsured is unlikely to be fully financed, leading to even greater financial burdens on the uninsured and higher levels of unmet need for health care services.
• If Congress partially repeals the ACA with a reconciliation bill like that vetoed in January 2016 and eliminates the individual and employer mandates immediately, in the midst of an already established plan year, significant market disruption would occur. Some people would stop paying premiums, and insurers would suffer substantial financial losses (about $3 billion); the number of uninsured would increase right away (by 4.3 million people); at least some insurers would leave the nongroup market midyear; and consumers would be harmed financially.
• Many, if not most, insurers are unlikely to participate in Marketplaces in 2018-- even with tax credits and cost-sharing reductions still in place-- if the individual mandate is not enforced starting in 2017. A precipitous drop in insurer participation is even more likely if the cost-sharing assistance is discontinued (as related to the House v. Burwell case) or if some additional financial support to the insurers to offset their increased risk is not provided.

We asked several of the most promising freshmen members of Congress what they think Democrats should do to protect their constituents. Aware of his outstanding record of leadership on tough, crucial issues in the Maryland legislature, Jamie Raskin was one of the first candidates Blue America endorsed in 2015. He beat a pack of wealthy, predatory self-funders in the primary and went on to win the general election with 60% of the vote. He's someone we'll be looking to for many years, not just for good votes, but for good ideas and strategies. This morning he asked rhetorically, "What kind of leaders seek to dismantle a program that provides health coverage to 20 million Americans? This is political malpractice in a democracy. Every American needs health care, not just billionaires and CEOs. TrumpCare is exactly what the doctor didn't order."

DWT is taking another look at Congressman-elect Ro Khanna, who defeated Mike Honda in a hard-fought run-off last month. Khanna has joined the Progressive Caucus and vowed to make a positive difference in the lives of California working families. Back from the freshman congressional sessions at Harvard University's Kennedy School of Government this week, he told us that "Jack Kingston, a former member of Congress and senior Trump advisor, openly told freshman members of Congress at our Harvard orientation that Trump's first priority will be to repeal the Affordable Care Act. He said every Republican needs to be for that because they must have campaigned on it."

All Democrats must make the defense of the Affordable Care Act our highest priority. We need to make the case that repeal will hurt working class Americans most-- many in districts that Trump carried. At a time when unfair trade deals and automation are hurting working families in middle America, we simply cannot afford to strip millions of Americans of basic health insurance.

As someone who was in the Obama Administration when the Affordable Care Act passed in 2010, I will play a leadership role to make the case why we must fight with every fibre of our being to keep it. I recognize as one of only two Obama Administration alum in the U.S. Congress and Senate that I have a unique responsibility.

Long term, we need to work towards a single payer system and Medicare for all. We can't take a step back now.