Trump Briefly Discussed His Health Care Proposals In PA Speech

Politico: Trump “Vowed To Immediately Repeal And Replace” Obamacare In A “Special Session” Of Congress. Politico reported that at a November 1 rally in Valley Forge, Pennsylvania, Republican presidential nominee Donald Trump “vowed to immediately repeal and replace” the Affordable Care Act (ACA) and called for a “special session” of Congress to do so. The article noted that “Trump called for replacing Obamacare with health savings accounts,” “allow[ing] Americans to purchase insurance across state lines,” and “empowering states to manage Medicaid funding.” From the November 1 article: 

Donald Trump on Tuesday vowed to immediately repeal and replace President Barack Obama’s signature health care law if he’s elected president next week.

“When we win on Nov. 8 and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare. We have to do it,” Trump said Tuesday afternoon in an address on the Affordable Care Act in King of Prussia, Pennsylvania.

“I will ask Congress to convene a special session so we can repeal and replace,” he continued. “And it will be such an honor for me, for you and for everybody in this country because Obamacare has to be replaced. And we will do it, and we will do it very, very quickly. It is a catastrophe.”

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Trump called for replacing Obamacare with health savings accounts that would allow Americans to purchase insurance across state lines and empowering states to manage Medicaid funding.

“We will create quality, reliable, affordable health care in a free market where parents can make the health care decisions that they really wanna make for their families,” Trump said. “It will be a much better health care at a much less expensive cost.”

Despite billing his address as a joint speech with his running mate, Indiana Gov. Mike Pence, on Obamacare — which included some members of Congress in attendance — Trump veered into his stump speech, speaking on issues like restoring manufacturing jobs, repealing Common Core, lowering taxes and rebuilding the nation’s military. [Politico, 11/1/16]

Media Figures Praise Trump’s “Very Good” Speech For “Going Deep Into Policy”

Wash. Post’s Chris Cillizza: “Donald Trump Gave A Very, Very Good Speech Today In Pennsylvania.” The Washington Post’s Chris Cillizza argued that while “Trump isn’t terribly good at delivering speeches,” his Valley Forge speech “was one of his best,” describing Trump as “a disciplined and effective messenger.” Cillizza declared that “Trump actually stuck to the script,” calling the candidate’s description of the ACA premium hikes “a great message for Trump.” He lauded the “flawlessly executed” introduction to the speech, and concluded by calling it a “genuinely effective speech.” From the November 1 article:

Donald Trump isn't terribly good at delivering speeches. He tends to bounce between a rote recitation of the words in the teleprompter and wild message detours into controversial territory that grab headlines and totally distract from the message he and his team are hoping to push on any given day.

Which is what makes his speech on Tuesday in Pennsylvania all the more remarkable. This was Trump at the best I have seen him in months — a disciplined and effective messenger giving a speech that, to my ear, was one of his best.

Start from the top. The whole event, which featured a rotating cast of doctors-and-nurses-turned-Republican members of Congress, was aimed at highlighting how the Affordable Care Act had failed to live up to the promises Democrats made about it. (Tuesday was the first day for open enrollment in the federal health insurance marketplace for 2017.) The run-up to his speech was flawlessly executed for Trump to use Obamacare as an example of how Hillary Clinton represents more of the same sort of policies that Democratic politicians have been pushing for years. And, unlike so many times over the past few months, Trump actually stuck to the script.

“Obamacare is a catastrophe,” he said. “The president said if you like your plan you can keep your plan, if you like your doctor you can keep your doctor — which may go down as one of the great political lies of the century. Even the skeptical Democrats believed him and approved the legislation. … No one ever read … the 2,700-page bill.”

That's a great message for Trump. The ACA has long been viewed deeply negatively not only by Republicans but also by independents that Trump desperately needs. The chart below makes that point — using data from the Kaiser Family Foundation poll:

And the news last week that the average premium for someone in the federal marketplace would rise 25 percent in 2017 is just the sort of “they aren't telling you the truth, folks” moment that fits like a glove into Trump's messaging.

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What struck me most about the speech — aside from how well written and delivered it was — was that it laid bare how simply Trump could have constructed a winning message in this campaign. Cast Clinton as the status quo. Make her own every policy and every controversy of the previous Clinton and Obama administrations. Use your own life as a the best possible evidence that true change can only come from without, that the political system needs a radical overhaul that only someone as well versed in business as yourself knows how to execute. And spend most of your days from Labor Day until Nov. 8 in Ohio, Florida, Pennsylvania and Michigan hammering away at the idea that only you, to borrow a phrase, know how to make America great again. [The Washington Post, 11/1/16]

Fox’s John Roberts: Trump Went “Deep Into Policy” In PA Speech. Fox News correspondent John Roberts claimed that Trump went “deep into policy” about heath care during a speech in Valley Forge, Pennsylvania, “where he promised to repeal and replace” Obamacare. Roberts emphasized that Trump was “upping the ante” by “saying he would make this a big priority” and calli a special session of Congress to repeal the health care law. From the November 2 edition of Fox News’ Fox & Friends:

JOHN ROBERTS: Donald Trump yesterday continued to highlight Hillary Clinton's lingering problems with the FBI investigation. He'll do that again today, but also going deep into policy yesterday with a speech in Valley Forge, Pennsylvania, on Obamacare. Of course, he’s promised to repeal and replace it, but upping the ante yesterday, saying that he would make this a big priority and would do that through Congress with a very interesting way to do it. [Fox News, Fox & Friends, 11/2/16]

Fox’s Carl Cameron: Trump’s PA Speech “Undercuts” Criticisms That “Donald Trump Wasn’t Putting Forth Policy.” Fox correspondent Carl Cameron declared that Trump’s PA speech “was about policy,” praising Trump for being “very studious, very disciplined” about his message on the Affordable Care Act. He claimed that the crowd at Trump’s rallies “loves the policy part of this” and argued that it “undercuts what was a year and a half of the media … saying that Donald Trump wasn’t putting forth policy.” From the November 1 edition of Fox News’ On the Record:

CARL CAMERON: This was about policy, something that Trump has been very studious, very disciplined about for the last week and a half when the Obama administration announced that they were, in fact, going to be increasing premiums for the Affordable Care Act next year. This is how Trump advanced his policy proposal today in Valley Forge.

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CAMERON: Pence was part of that, and he talked about what Trump's plan actually is: do away with Obamacare, create health savings accounts, foster more interstate commerce for health insurance, much the way car and life insurance is sold, and allow block granting of Medicare -- Medicaid money to the states so that they can handle it. That is the entire -- that's essentially the totality of what Trump would do in lieu of Obamacare.

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BRIT HUME (HOST): When he talks about these issues and delivers his point by point presentations as to how he is going to deal with Obamacare say, how is the audience response to that?

CAMERON: They are responding very, very favorably. And about audience response, this thing is about to start and the line goes -- I can see about a quarter of a mile, a third of a mile, and the line is four and five across and it’s still going. A lot of folks aren't going to get in tonight. The capacity of the hall that he is in is 3400. And it's already elbow to elbow. And this has been happening quite a bit. The crowd loves the policy part of this. It, in many ways, undercuts what was a year and a half of the media, and the critics, and the analysts, and a lot of his Republican opponents saying that Donald Trump wasn't putting forth policy. It's not just the Affordable Care Act and its repeal. His Contract for the American Voter ticks off a dozen different ideas, policy promises. Not so much specifics in the aggregate, but they love that stuff. [Fox News, On the Record, 11/1/16]

Wash. Post: “Trump Swerved Back On Script” With “Streamlined Policy Imperatives.” The Washington Post claimed “Trump swerved back on script” during his speech, which showed “flashes of a cohesive closing argument.” In particular, the article claimed “Trump offered streamlined policy imperatives for supporting him,” pointing to Trump’s declaration that “if we don’t repeal and replace Obamacare, we will destroy American health care forever.” From the November 1 article:

Donald Trump swerved back on script Tuesday, showing flashes of a cohesive closing argument in the final stage of a presidential campaign that is tightening with six days left.

Joined here by his running mate, Indiana Gov. Mike Pence, and a small group of lawmakers, Trump delivered an uncharacteristically disciplined speech calling again for the eradication of the Affordable Care Act and a renegotiation of a sweeping trade pact he cast as a job killer — championing causes popular among many Republicans in Rust Belt states such as Pennsylvania, Michigan and Wisconsin, where he is urgently trying to expand the map against Hillary Clinton.

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Inside a hotel ballroom here before an invitation-only crowd, however, Trump offered streamlined policy imperatives for supporting him.

“If we don’t repeal and replace Obamacare, we will destroy American health care forever,” he said, referring to the Affordable Care Act championed by President Obama. [The Washington Post, 11/1/16]

Fox’s Kilmeade: “Trump Was Actually Getting Cheers Because He Was Talking About Policy.” Fox host Brian Kilmeade lauded Trump’s PA speech, claiming that “Trump was actually getting cheers because he was talking about policy yesterday, including Obamacare when sign-ups began.” From the November 2 edition of Fox News’ Fox & Friends:

BRIAN KILMEADE (CO-HOST): Ainsley, that's my exact point is that Donald Trump was actually getting cheers because he was talking about policy yesterday, including Obamacare when sign-ups began because it was very apropos to what's happening. Hillary Clinton, and to a degree, I think that she's getting a little desperate. When you wheel out Alicia Machado, who can barely speak English, in Florida to plead your case not to vote for the other guy, instead of saying, “This is what I will do as president after the fireworks show when I celebrate, this is what I'm going to do.” Instead she’s like, “Oh you're not going to believe how bad the other guy is.” While President Obama's out there saying, “Oh by the way if you don't vote for her, you just don't like women. You're sexist.” [Fox News, Fox & Friends, 11/2/16]

WSJ: Trump’s “Focus” On The ACA Was A “Detour Into Policy And Economic Issues.” The Wall Street Journal described Trump’s speech as a shift toward “focusing on voters’ pocketbook issues,” noting that Trump “renewed his call to repeal and replace the law known as Obamacare.” The article emphasized that “the focus on the impact of the health-care law took the campaign into an unusual detour into policy and economic issues.” From the November 1 article:

Donald Trump turned from attacking Hillary Clinton over her emails to focusing on voters’ pocketbook issues Tuesday, denouncing President Barack Obama’s health-care law and the recent rise in individual insurance premiums.

The Republican presidential nominee renewed his call to repeal and replace the law known as Obamacare on the first day of the official sign-up period for coverage under the law, and in the wake of significant rate increases in many battleground states.

“Obamacare means higher prices, fewer choices and lower quality,” Mr. Trump said, promising to call a special session of Congress to spur action on repealing the health-care law. “It is a catastrophe.”

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The focus on the impact of the health-care law took the campaign into an unusual detour into policy and economic issues that are of direct concern to voters in a campaign that has been dominated by personal attacks. [The Wall Street Journal, 11/1/16]

Trump’s “Policy” Speech Was Filled With Recycled Ideas, False Promises, And Bad Policy

Bloomberg Politics: “Trump’s Anti-Obamacare Speech Sheds Little Light On Replacement.” Bloomberg Politics reported that Trump’s speech “offered no new details about his plan to replace Obamacare,” explaining that the “ideas outlined in Valley Forge … were included in a white paper he unveiled in March,” which was “a vague blueprint … that features many of the same ideas Republicans have considered for years.” From the November 1 article:

In what his campaign billed as a major health-care speech Tuesday, Donald Trump offered no new details about his plan to replace Obamacare, but re-emphasized the need to repeal the 2010 law.

The ideas outlined in Valley Forge, Pennsylvania, by the Republican presidential nominee—tax-free health savings accounts, insurance across state lines and sending Medicaid funds to states—were included in a white paper he unveiled in March. They largely match proposals popular among conservative policy advocates.

If elected president, Trump said he would ask Congress to convene a “special session” to repeal and replace the Affordable Care Act, invoking the legislative branch's power to come together during adjournments. However, Congress is already scheduled to be in session by the time he would take office.

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Trump has excoriated the health-care law since the first day of his campaign as a “disaster,” but concluded that it was “blowing up” when the Obama administration announced that premiums for benchmark mid-level health plans were increasing by 22 percent for next year, on average.

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While he's repeatedly vowed to repeal Obamacare, Trump has been far less clear about what would replace it.

In March, Trump rolled out a vague blueprint for replacing Obamacare that features many of the same ideas Republicans have considered for years: selling insurance across state lines, tax-free health savings accounts, or HSAs, and block-granting Medicaid for states. He has also called for allowing the re-importation of cheaper drugs from abroad, a break from many fellow Republicans.

“We have to get rid of the lines around the state, artificial lines, where we stop insurance companies from coming in and competing,” Trump said at the second presidential debate last month. “We want competition.” [Bloomberg, 11/1/16]

New York Magazine: Trump’s Call For A “Special Session Of Congress” Is “A Real Head-Scratcher.” According to New York magazine, Trump’s call for a “special session” to repeal the ACA “makes no sense at all.” The article noted that “the next Congress will convene on January 3, 2017, 17 days before the next president is inaugurated,” and that “even if Trump is talking about not waiting until next January” to repeal the ACA, “there’s no need for a special session” because “Congress is already scheduled to reconvene in November.” The article also points out that “even if a special session was needed, Trump would have no power to call for one.” The article also pointed out that “Trump and Pence did not offer a specific replacement plan in their Pennsylvania speeches today.” [New York magazine, 11/1/16]

Kaiser’s Larry Levitt: Trump’s Proposal To Allow Insurance Companies To Offer Health Insurance Across State Lines Would Leave “People With Preexisting Conditions Without Access To Insurance.” Kaiser Family Foundation’s Larry Levitt criticized Trump’s proposal to allow “health insurance companies to sell plans across state lines,” noting that “would actually worsen access to coverage for people with preexisting conditions” because “insurers would have a strong incentive to set up shop in states with minimal regulation, undermining the ability of other states to enact stricter rules.” From the October 19 article:

In the recent presidential debate, moderator Anderson Cooper asked Donald Trump how he would “make coverage accessible for people with preexisting conditions” if the Affordable Care Act (ACA) is repealed.

Trump responded: “Once we break out—once we break out the lines [around the states] and allow the competition to come…when we get rid of those lines, you will have competition, and we will be able to keep preexisting, we’ll also be able to help people that can’t get—don’t have money because we are going to have people protected.”

What Trump is talking about here is allowing health insurance companies to sell plans across state lines. Could it protect people with preexisting conditions? In a word, no. In fact, it would likely have just the opposite effect.

To understand why requires a bit of wonky background on how health insurance regulation works.

Historically, states have regulated health insurance. To sell coverage in a state, an insurance company has to obtain a license in that state and follow all of its rules. State rules varied quite a bit. Some required insurers to cover a broad set of benefits, while others mandated more narrow coverage. A handful of states—Maine, Massachusetts, New Jersey, New York, and Vermont—required insurers to sell coverage to people with preexisting health conditions, but the vast majority did not.

The ACA included a comprehensive set of insurance market reforms, primarily affecting the individual and small business insurance markets. Beginning in 2014, the law required insurers to guarantee coverage regardless of preexisting conditions, prohibited rate surcharges for people who are sick, limited variation in premiums due to age, and established a minimum benefit package.

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Repealing the ACA—as Trump has proposed—would return insurance markets to their pre-ACA state, leaving people with preexisting conditions without access to insurance in the vast majority of states.

Allowing insurers to then sell plans across state lines would actually worsen access to coverage for people with preexisting conditions, since insurers would have a strong incentive to set up shop in states with minimal regulation, undermining the ability of other states to enact stricter rules.

[...]

The idea of guaranteeing access to insurance for people with preexisting conditions has bipartisan appeal. But, making such protections work requires some mechanism to share in the cost of health care for people who are sick. Under the ACA, that mechanism is the so-called “individual mandate,” which helps to get healthy people to sign up for insurance to balance out the cost of those who are sick. A high-risk pool could also work, if it’s adequately funded (which has not been the case for such efforts in the past). Simply getting rid of the “lines around states” wouldn’t make coverage available to people with preexisting conditions, or meaningfully enhance competition among insurers. [News at JAMA, 10/19/16]

Chicago Tribune: Erasing State Lines Would Create “A Race To The Bottom” In Insurance Markets And Worsen “Coverage Gaps And Disparities.” Chicago Tribune columnist Eric Zorn rejected Trump’s claim that “it’s those dreaded, pesky state lines that make health insurance so darn expensive,” noting that his proposal to eliminate those state lines would create “a race to the bottom” in order to “set the regulatory bar as low as possible in order to lure corporate headquarters and the jobs and taxes they generate.” Zorn’s column criticized Trump’s idea that “it’s merely burdensome regulations that discourage carriers from offering low-cost health care policies” to individuals with “chronic, expensive conditions,” noting that his proposal would cause “dramatically higher premiums” that would worsen “the coverage gaps and disparities that the 2010 Patient Protection and Affordable Care Act (Obamacare) attempted to address.” From the October 14 column:

To hear Republican presidential nominee Donald Trump tell it, it's those dreaded, pesky state lines that make health insurance so darn expensive. Erase them and … well, let's listen to him discuss the issue during the second presidential debate Oct. 9:

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Contra Trump, current state laws do not “stop insurance companies from coming in and competing.” Blue Cross and Blue Shield, Aetna, Humana and so on are all welcome to get licensed in any state they wish and set up shop to compete with other insurers to sell coverage at the best price.

When they enter a market, however, they must abide by the regulations in those states designed to protect the interests of patients and providers.

Advocates for allowing the sale of health insurance “across state lines” are really talking about allowing an insurer based in, say, Kansas, to sell plans to, say, Illinois residents that follow the regulatory guidelines in Kansas rather than the regulatory guidelines in Illinois.

The “competition in the insurance industry” Trump dreams of would actually be a competition among the states; competition to set the regulatory bar as low as possible in order to lure corporate headquarters and the jobs and taxes they generate.

The beloved market forces dictate that such competition would be a race to the bottom — similar to the de-regulatory battle that saw nearly all major credit card companies end up located in Delaware, Nevada and South Dakota, where the credit-banking laws are the most lax.

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Would some customers get a better deal that way? Sure. Younger, healthier people would probably pay dramatically lower premiums for bare-bones policies adequate for their demographic group. Middle-aged and less healthy people would probably pay dramatically higher premiums if they could find coverage at all, thus making worse the coverage gaps and disparities that the 2010 Patient Protection and Affordable Care Act (Obamacare) attempted to address.

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Trump's idea — “When we get rid of those lines, you will have competition, and we will be able to keep (providing affordable coverage to people with) pre-existing (medical conditions)” — assumes, crazily, that it's merely burdensome regulations that now discourage carriers from offering low-cost health care policies to cancer patients, diabetics and others living with chronic, expensive conditions.

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Once again Trump is incoherently spouting bad ideas.

Once again, no one who has been paying attention is surprised. [Chicago Tribune, 10/14/16]

Huff. Post: Trump’s Health Care Plans “Would Be Useful Mainly To Higher-Income Households” And Would “Raise Rates On Older People.” The Huffington Post’s Jeffrey Young analyzed Trump’s health care proposals and concluded that his plans would not “offer much relief … especially to those who were uninsured before Obamacare.” Young noted that the proposal to replace subsidies with “a tax deduction … would be useful mainly to higher-income households” and the proposal for “converting Medicaid to a “block grant” of money to states” is “equivalent to a massive funding cut.” Young emphasized that Trump’s proposals would allow insurance companies “to resume now-illegal practices like excluding people because of their medical histories or charging them more, allowing insurers to raise rates on older people.” From the November 1 article:

A review of Trump’s own plans doesn’t indicate he would offer much relief, either, especially to those millions who were uninsured before Obamacare and would be uninsured without it. It’s a far cry from Trump’s February promise: “I will not let people die on the streets for lack of health care.”

Trump, similar to House Republicans, would eliminate health insurance subsidies and replace them with a tax deduction of lesser value and that would be useful mainly to higher-income households.

Likewise, Trump and other Republicans favor converting Medicaid to a “block grant” of money to states, which is equivalent to a massive funding cut. In place of the Affordable Care Act’s guarantee of coverage regardless of pre-existing conditions, Trump calls for a weaker policy that only allows those individuals access to insurance if they’ve never been uninsured before.

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Trump’s purported replacement for the regulated insurance exchanges, where basic benefits are guaranteed and no one can be excluded, is to permit health insurance companies to resume now-illegal practices like excluding people because of their medical histories or charging them more, allowing insurers to raise rates on older people (as a way of reducing rates for younger ones).

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Another favorite GOP proposal that’s part of Trump’s agenda is expanding the use of health savings accounts, which are tax-free vehicles where money can be set aside for medical expenses. These accounts must be paired with high-deductible health plans, a fact Trump ignores while criticizing exchange coverage for having high deductibles.

Trump may or may not understand any of this, considering his previous statements on health care policy have been all over the place. [The Huffington Post, 11/1/16]

Repealing Obamacare Would Double The Uninsured Rate And Add Billions To The Deficit

CNBC: Repealing Obamacare Would Result In “More People Without Health Insurance Than Before The Law Went Into Effect.” In June, CNBC reported on a study from the Urban Institute finding that, if Congress repealed Obamacare, “there could end up being more people without health insurance than before the law went into effect.” The study found that “a total of 24 million more people would lose health coverage by 2021,” which would make the uninsured rate “higher in 2021 without the ACA than it was in 2013,” before the health law was implemented. The article noted that “it is not clear to what extent Trump's proposals would make up for the loss of health insurance by millions of people if Obamacare were repealed.” From the June 13 article:

If the next president and Congress repeal Obamacare — as many Republican elected officials want to do — there could end up being more people without health insurance than before the law went into effect, a new study says.

A total of 24 million more people would lose health coverage by 2021 if the Affordable Care Act was repealed, according to the study issued Monday by the Robert Wood Johnson Foundation and the Urban Institute.

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As a result, the uninsured rate would nearly double, to 19.4 percent of the U.S. population by 2021, according to the study.

“Thus, the uninsurance rate would be higher in 2021 without the ACA than it was in 2013,” the year before the Obamacare law began taking full effect, a report on the study said.

In 2013, there were 47.5 million people, representing 17.6 percent of the population, who lacked insurance.

Matt Buettgens, senior research associate at the Urban Institute, and a co-author of the report, said, “It would be an unprecedented disruption of coverage.”

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The study comes as presumptive Republican presidential nominee Donald Trump has called for an end to the ACA, as top GOP officials have also demanded. At the same time, Trump has proposed a replacement plan that he says will “broaden health-care access” and “make health care more affordable.”

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But it is not clear to what extent Trump's proposals would make up for the loss of health insurance by millions of people if Obamacare were repealed.

Buettgens said Trump's replacement plan did not have enough details to analyze how many people would end up having health insurance if Obamacare were repealed.

“Without specific details” such as how much states would get in block Medicaid grants “it's impossible to know how they would impact things,” he said.

[...]

According to the Obama administration, about 20 million people have gained coverage so far because of the ACA. And the nation's uninsurance rate is, for the first time ever, below 10 percent. [CNBC, 6/13/16]

NPR: Repealing Obamacare “Would Add $137 Billion To The Deficit Over The Next Ten Years.” NPR reported that, according to the nonpartisan Congressional Budget Office, “repealing the Affordable Care Act's spending cuts and tax increases would add $137 billion to the deficit over the next ten years.” The CBO report emphasized that “over the long term, repeal would add even more to the deficit” and that “the estimated effects on deficits of repealing the ACA are so large in the decade after 2025” that it is “unlikely that a repeal would reduce deficits during that period.” From the June 2015 article:

Congress' official scorekeeper says repealing Obamacare would increase the federal budget deficit and the number of uninsured Americans by 24 million.

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The report says repealing the Affordable Care Act's spending cuts and tax increases would add $137 billion to the deficit over the next ten years, and the number of people with health insurance would drop from 90 percent of the population to 82 percent.

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Politico says the CBO report could have political implications:



"The estimate will make it harder for Republicans to use so-called reconciliation to repeal the law because congressional budgeting rules bar lawmakers from using the parliamentary maneuver to move legislation that adds to government red ink.

The CBO report said over the long term, repeal would add even more to the deficit:

“Repealing the ACA would cause federal budget deficits to increase by growing amounts after 2025, whether or not the budgetary effects of macroeconomic feedback are included. That would occur because the net savings attributable to a repeal of the law's insurance coverage provisions would grow more slowly than would the estimated costs of repealing the ACA's other provisions—in particular, those provisions that reduce updates to Medicare's payments. The estimated effects on deficits of repealing the ACA are so large in the decade after 2025 as to make it unlikely that a repeal would reduce deficits during that period, even after considering the great uncertainties involved.” [NPR, 6/19/15]

Mother Jones: Repealing Obamacare Would Cause “Havoc In The Markets.” In 2015, Mother Jones investigated the impact of repealing Obamacare, reporting that “many people would immediately lose coverage because they could no longer afford it,” while “others could be kicked off their plans” for “preexisting conditions.” The article quoted Linda Blumburg, a health care policy analyst, who explained that a swift repeal of the ACA with “no transition period” would cause “havoc in the markets.” Other experts noted that “the ACA has so fundamentally changed the health care system” that “returning to the way things were is no longer possible.” From the February 2015 article:

“If you with a stroke of a pen took the Affordable Care Act away and there was no transition period, there would essentially be havoc in the markets,” says Linda Blumburg, a health care policy analyst. It's a hypothetical not too far from reality since the Supreme Court could gut the law in a decision this summer—an outcome that Republicans strongly support, even while they lack a legislative response to what would be a disastrous scenario for millions of their constituents.

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Without subsidies to purchase insurance, many people would immediately lose coverage because they could no longer afford it. Others could be kicked off their plans without Obamacare's protections for people with preexisting conditions. “You would just have an awful lot of people be uninsured, and then that ripples back through the health care system,” Jost says. “Basically, you would have a lot of people die because they couldn't get health care.”

This is just the tip of the iceberg. A roll back of the Medicaid expansion would cause millions more Americans to lose their coverage and create mayhem for state governments. Without the ACA to plug the so-called “doughnut hole” for prescription drugs, seniors would see their drug bills go up.

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By now, the ACA has so fundamentally changed the health care system that repeal would not simply return the country to its pre-Obamacare state. The Urban Institute estimates that just rolling back subsidies for people in states with federally run exchanges—the Supreme Court scenario—would create such turmoil in the private insurance market that the number of people in 2016 buying private plans on their own would be substantially lower (just over 1 million) than if the ACA had never been implemented (about 7.3 million). In other words, destroying the exchanges would be much worse than if they were never implemented at all. Returning to the way things were is no longer possible.

Repeal would be bad for insurers as well as customers by causing at least short-term turmoil for insurance companies. Without an individual mandate and without subsidies to make insurance affordable, younger, healthier people would likely drop their coverage, leaving insurers to cover older, sicker people with more health care needs. But insurance companies can't raise premiums until next year because the 2015 rates have already been locked in—at the very least, it would take months to renegotiate rates with each state. The result, according to Blumberg, a coauthor of the Urban Institute report, could be that companies spend more on coverage than they bring in on premiums. Not exactly a problem these companies are looking forward to. [Mother Jones, 2/3/15]