Health Beat: What America Looks Like Without Obamacare
It’s hard to find winners if the Affordable Care Act is repealed, but there would be no shortage of losers.
President-elect Donald Trump has promised to repeal the Affordable Care Act as one of his first actions of his presidency.
Trump, of course, is not the most predictable incoming president, and indeed he’s already implied that he might try to retain a couple of features of Obamacare.
The threat of repeal has been wielded many times since its rollout in 2010. Since then, 21 million more Americans have been able to acquire health insurance, and even for those who were already insured, the potential of a repeal would have far-reaching effects.
How might the health care system change if the ACA suddenly disappeared entirely?
First, there would be the loss of insurance for those 21 million people. Subsidies would be gone. Medicaid expansion, gone.
Every health insurer that provides a plan now would lose a substantial number of customers. Companies have to make money, so they would charge everyone else more to cover their costs.
Jobs would be lost. If fewer policies are issued, insurance companies need fewer workers.
One feature that Trump has indicated he might try to retain is the ban on pre-existing condition exclusions.
Before the ACA, companies were allowed to reject someone鈥檚 application for insurance based on any prior health conditions. If someone had a history of cancer, they might not have been able to acquire health insurance.
In a pro-business environment, the less cost to the company, the greater the profits. That means sick people would be left out, and insurance would be offered preferably to the healthy.
Where would these people rejected by the insurance industry go to get care?
Most likely emergency rooms, which leaves them either in personal debt or a hospital with unpaid bills. Hospitals cannot operate indefinitely in an environment where the care provided is uncompensated.听厂辞听fewer hospitals would remain open, and those that do would charge everyone else more money to cover for the losses of the free care they provided.
Young adults ages 18-26 would no longer be allowed on their parent鈥檚 plans (although this is something else that Trump has said he’d like to retain). That would add to the ranks of the uninsured and lead to even greater problems with higher premiums paid by those who have insurance to compensate for the companies’ losses. Usually healthy people pay more in premiums than they utilize in costs, but only the wealthy-healthy would be able to purchase coverage.
Elimination of Obamacare’s employer mandate for insurance and the personal mandate would also lead to more people being uninsured. Those who have coverage could still get care, but health care costs at facilities aren鈥檛 going down. The only way to make up the difference if fewer patients are going to clinics and hospitals is to charge more for services.
What happens when premiums go up? Employers might bear some of the burden and cut costs elsewhere by not hiring new workers or cutting spending elsewhere.
Obamacare mandates complete coverage for preventative services. Without that people might be included to forgo colonoscopies, mammographs and cholesterol screening. This would not lead to a healthier population. When serious conditions aren’t caught early, they result in greater treatment costs, which leads to the trickle down effect on everyone else鈥檚 premiums.
The few comments Trump made as a candidate about alternatives to Obamacare focused on health savings accounts and on allowing insurance coverage to be purchased across state lines. Both have their own unique challenges.
Health savings accounts have been around for years, helping those who have anticipated health expenditures beyond their insurance coverage to receive their own money back, pre-tax, when they have had to pay for services. They work for those who have money to spare to put in a separate account. What happens to those who don鈥檛 have any left over money to put away for a health expense? Once again, if sick enough, they go to the ER. Otherwise, they just don’t get the care they need.
Purchasing insurance across state lines is a nice idea, but insurance companies are not in the business of providing plans that don鈥檛 make money to enhance their bottom line. Companies that are small might not be able to compete and would close. A monopoly of plans could ensue, which eliminates competition and allows one or two companies to set the rates they choose, with little hope of negotiation.
How will Americans be affected in the next four years if fewer people have insurance and can鈥檛 afford to get care?
They’ll be sicker. And paying more for their care if they have insurance and going further into debt if they don鈥檛.
It’s a business model that doesn鈥檛 work for anyone.
