Trumpcare, formally the American Health Care Act, would lead to 14 million more uninsured Americans next year and 24 million more uninsured by 2026 relative to current law, according to a recent nonpartisan analysis. Turns out, that’s actually an even bigger drop in health coverage than what would happen with a straight repeal of the Affordable Care Act, also known as Obamacare.
The New York Times’ Margot Sanger-Katz points out that earlier studies by the Congressional Budget Office (CBO) —the independent scorekeepers who keep tabs on how legislation affects the budget and the country and whose report on the GOP repeal-and-replace effort last week sent Obamacare opponents into disarray—found that simply repealing Obamacare would only lead to 23 million fewer uninsured Americans. That’s a one million-person improvement over Trumpcare.
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The AHCA attempts to preserve certain Obamacare components (mandating coverage for Americans with pre-existing conditions, requiring insurers to provide certain benefits, etc) while massively scaling back others (including the Medicaid expansion which has covered millions of low-income people and replacing more generous insurance subsidies with optional tax credits that can be used to buy coverage).
But this have-it-both-ways approach could wreak havoc on insurance markets, leading to big coverage losses over the long-term and premium hikes in the short-term, according to CBO and other groups.
The fact that a clean repeal could actually preserve insurance coverage for more Americans underscores the complexities and tradeoffs in health care policy, where an imbalanced mix of policy carrots and sticks can lead to a perfect storm of market chaos.
Full-fledged Obamacare repeal without a replacement would lead different people to lose coverage compared with the AHCA, as the Times notes. For instance, the AHCA would disproportionately affect people with employer-provided insurance and older, poorer Americans.
House Republicans and President Donald Trump are attempting to rally support for the AHCA in Congress amid a growing flurry of criticism from conservatives and moderates alike. Proposed changes to the legislation introduced on Monday may actually lead to even more widespread coverage losses. The House is expected to vote on the Obamacare bill on Thursday, the anniversary of President Barack Obama signing the Affordable Care Act into law.