If you listened to congressional Republicans in the run-up to last November’s election, one phrase repeated over and over was: “Repeal Obamacare.” It was a mantra. Many members in the House of Representatives had already voted dozens of times to repeal the Affordable Care Act since its 2010 passage and were chomping at the bit to do it for real. Unfortunately for them, reality has set in. It is now clear that repealing the ACA is a political impossibility without a replacement, and while Republicans have had six years to craft their replacement, they still have nothing to show for it.
According to a recent Kaiser Health Tracking Poll, the public’s top priority for the new Congress involves reducing out-of-pocket costs for health care, followed by lowering the price of prescription drugs. More than six in 10 rate these as their highest priorities. Sixty-two percent also prefer a federal guarantee of coverage compared to 31 percent preferring a more limited federal role. A meager 20 percent believe Congress should repeal the ACA without providing the details of a replacement.
Why do so many believe a repeal to be such a bad idea? The Affordable Care Act provides health insurance to 22 million people nationwide and offers income-based subsidies for the purchase of ACA marketplace insurance. In North Carolina, 499,178 residents receive their coverage with the help of ACA subsidies. Many families also receive support to cover cost-sharing, such as co-payments. The loss of this combined support will cost each recipient an average of $6,943 in 2019. Additionally, Medicare enrollees in North Carolina benefit from lower prescription drug costs thanks to the ACA. The elimination of this price protection will cost Medicare enrollees an average of $1,013 a month.
The ACA has also closed the coverage gap between African-American and white children, narrowed that gap among adults and delivered the biggest reduction in uninsured rates to Latinos. It has also made the Indian Health Care Improvement Act permanent, and has provided states with opportunities to develop public systems as an alternative to private coverage offered through insurance companies. If the ACA were eliminated, all these advances would vanish.
Eliminating health care for 22 million people will come with substantial human and economic costs for jobs, state budgets, and hospitals. By 2019, ACA repeal would eliminate $61 billion nationally in tax credits from those who currently depend on these subsidies to afford health insurance. Repeal also would cut $78.5 billion in federal grants to states for the expansion of Medicaid, potentially wreaking havoc on state budgets.
Researchers estimate a loss of approximately 2.6 million jobs nationwide due to repeal by 2019, with a loss of 76,200 of those jobs in North Carolina. The job loss will first hit the health care sector, then ripple out to other sectors as a result of lost wages and reduced purchasing of goods and services.
Eliminating the health insurance provided by the ACA will reduce revenue to hospitals, community health centers, physician practices, and other providers. In 2019 alone, these providers will lose $146 billion nationwide. Meanwhile, they will be expected to deliver $88 billion in care to people no longer able to pay their bills. The only way for hospitals and doctors to avoid such costs would be to deny care. Both urban and rural hospitals expect to be especially hard hit, with some hospitals facing possible closure. North Carolina’s hospitals and physician practices will see their income reduced by $3.78 billion. North Carolina’s hospitals would see an increase of $818 million in uncompensated care and physician practices would see an increase of $410 million in uncompensated care.
Repealing the ACA would eliminate significant infusions of federal dollars into state economies and budgets – which also support schools, roads and other services – while loss of business output resulting from the withdrawal of ACA funds would additionally depress state and local tax revenues. Between 2019 and 2023, the loss of these funds will cost North Carolina residents $24.9 billion in federal funds. It will cost almost $1.2 billion in state and local tax revenue.
These are staggering numbers. We have no way of knowing yet what the replacement plan is to avoid these catastrophic consequences. After years of decrying the ACA as a disaster, it’s deeply disturbing that Republicans still have nothing coherent to say about how their plan will serve us better. Maybe it’s just politics to them, but to the rest of us it’s our physical and economic health on the line.
Kevin J. Rogers, JD is the policy director for Action NC, a statewide advocacy group, and a professor of political science at William Peace University in Raleigh.