The Republican ACA Repeal and Replace Scheme: A Guide for Progressives

By Toni Webb
State Director, For Ohio’s Future Action Fund

This week we saw the first, of what will likely be many, attempts by Congressional Republicans to find a replacement for the Affordable Care Act. The Cassidy-Collins  bill hit Washington like a lead balloon, being panned by the Associated Press as a non-starter that “could dismay conservative voters,” and the New York Times said this first attempt  “may serve to show how difficult it will be for Republicans to pass a bill to replace the Affordable Care Act.”

All politics aside, this “plan” does nothing to protect us from the devastating impacts of the Administration’s planned health care repeal efforts. Like other ideas Republicans have put forward, this legislation will make care less affordable and lower in quality. Tens of millions of Americans will lose the coverage they have today, out-of-pocket costs will soar, protections for the 133 million Americans with pre-existing conditions will be gutted, important benefits will be eliminated, and the safety net will be shredded.

The Administration and Congressional leadership don’t seem to be listening to the increasing fears of  people across America. We need Congress to pass a real plan that protects high-quality, affordable care before they rip apart the current system.

As progressives continue to fight for affordable health care for all Americans, we must continuously push the Ohio Congressional delegation to measure “replacement plans” based on the following common-sense questions:

  • Will everyone who has coverage today still have coverageunder this replacement plan?
  • Will this “plan” make coverage more affordable for people –  lowering their premiums, deductibles and out-of-pocket costs – while not taking away any of their current benefits?
  • Will everyone who currently gets a health insurance tax credit continue to receive the same amount or more so that they not only “have access to coverage” but can afford it?
  • Will this “plan”maintain the current protections for people with pre-existing conditions that are in the current law?
  • Will this “plan” guarantee that a woman can’t be charged more than a manfor her health insurance simply because she is a woman?
  • Will insurance companies in all states still be required to cover check-ups for kids, mammograms and birth control without co-pays? Will mental health and prescription drugsstill be covered at the same level?
  • Will this “plan” prevent insurance companies from charging people over 55 more than they are today?
  • Will everyone that is covered today throughMedicaid continue to have coverage without paying more?
  • Will this “plan” require large companies and other big employers to continue providing health coverage for their employees?
  • Will this “plan” cut taxes for pharmaceutical companies and the wealthiest?

Background on the Cassidy-Collins Bill

The Cassidy-Collins Bill will:

  • Reduce the number of Americans with health insurance;
    • The bill repeals all of title I of the Affordable Care Act (ACA), including the exchange subsidies, the individual and employer mandates, and all the“good” market reforms. States would be given the option to reinstate these reforms, but it is unlikely that it would be feasible for states to act in time to stop the ensuing chaos.
  • Repeal consumer protections protecting people with pre-existing conditions;
    • The bill only guarantees coverage if people maintain coverage for 12 months preceding enrollment. People with pre-existing conditions that don’t maintain continuous coverage either get a very limited benefit package or face a new, expensive enrollment penalty.
  • Increase deductibles; and  increase premiums.
    • The Congressional Budget Office (CBO) reported that repealing the individual mandate alone would raise premiums by twenty percent
  • Repeal essential health benefits (EHB), allowing for discrimination against patients.
    • EHB requires a comprehensive health benefit package, including prescription drugs, maternity coverage, mental health and substance use disorder benefits, birth control and others. The bill allows states to continue to require EHB coverage, but states would have to elect to do so
    • Repealing the EHB, would mean that maternity care would no longer be covered. Before the ACA, 88% of plans did not cover maternity care, meaning that rolling back this provision would make it harder to start families. [National Women’s Law Center, 2015]
  • Gives billionaires the same financial help as a low-income family.
    • Restructures benefits so it is based on age, not income.
  • Disrupts employer-based coverage for all families

The Cassidy-Collins Alleged “Plan” is already falling flat:

  • New York Times: “may serve to show how difficult it will be for Republicans to pass a bill to replace the Affordable Care Act”
  • AP: “could dismay conservative voters”
  • Morning Consult: “the proposal isn’t expected to garner broad GOP support”
  • The Hill: “could face blowback from conservatives”
  • Politico: “Keeping Obamacare’s taxes likely won’t sit well with many Republicans”
  • CNN: “It is not clear whether the legislation…would garner backing from party leadership”
  • Washington Post: “Cassidy said retaining the taxes, at least temporarily, is the only way to pay for the ACA benefits the GOP has ‘promised to maintain”
  • USA Today: “several controversial provisions…that could be nonstarters within their own party”
  • BuzzFeed News: “a tough sell for Republicans”

What’s really at stake for Ohioans?

Repealing the ACA means:

  • 964,000 Ohioans would lose health coverage, a 155 percent increase in the number of uninsured. [Urban Institute]
  • 1,919,000 Ohioans under the age of 65 living with pre-existing conditions could be denied health insurance if provisions of the Affordable Care Act are repealed. That’s 25% non-elderly population. [Kaiser Family Foundation]
  • Ohioans would lose $5.842 billion in federal financial assistance through the insurance marketplaces from 2019-2028, leading to a dramatic spike in the number of uninsured. [Urban Institute]
  • 174,488 Ohioans would lose an average monthly advanced premium tax credit of$250, which currently helps them pay for insurance. [Kaiser Family Foundation]
  • Ohioans would lose $42 million in federal Medicaid or Children’s Health Insurance Program (CHIP) funding, currently providing lifelines to 2,985,406 Ohioans . [Urban Institute, Kaiser Family Foundation]