Why ‘Repeal And Delay’ Would Be An Unmitigated Health Care Disaster

As Senate Republicans struggled in late June to muster the votes for a health care overhaul, Sen. Rand Paul (R-KY) threw a Hail Mary pass, urging his colleagues to vote on a bill that would simply repeal the Affordable Care Act without creating anything to take its place.

Asked by TPM how the pitch was received, Paul deadpanned: “Not very well. Lead balloon.”

That lead balloon got an injection of helium just a few days later, however, when President Donald Trump himself endorsed the plan:

If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!

— Donald J. Trump (@realDonaldTrump) June 30, 2017

This week, Sen. Ted Cruz (R-TX) hopped on the same bandwagon, telling reporters after a town hall: “If we cannot bring the conference together and agree on repeal legislation, then I think President Trump’s absolutely right that we should pass a clean repeal.” He joined the ranks of Paul and Sen. Ben Sasse (R-NE), who said on CNN: “We should do repeal with a delay — let’s be clear, I don’t want to see anybody thrown off the coverage they have now. I would want to delay so that we can get straight to work.”

But despite support from the commander in chief and those Republican lawmakers, there is a reason “repeal now and replace later” isn’t getting serious consideration in Congress: It would be an unmitigated disaster for the health insurance marketplace.

Dr. Alice Rivlin, the founding director of the Congressional Budget Office under presidents Ford, Carter and Reagan and the director of the Office Management and Budget under President Clinton, explained to TPM why such a move would have “a very devastating effect.”

“Lots of people would lose their insurance on the exchanges and on the expanded Medicaid program,” she said. “Also, the repeal would include the insurance market reforms in the Affordable Care Act, which many Republicans now profess to like, like the fact insurance companies can’t discriminate against unhealthy people.”

When Republicans asked the CBO to analyze the impacts of a “clean repeal” of Obamacare in 2015, the office found that not only would it kick tens of millions of people off their health insurance, it would also increase the federal deficit by more than $350 billion dollars over 10 years.

“That kind of repeal without a replacement would create enormous uncertainty and destabilize the individual insurance market, leading to big premium increases and insurer exits in 2018,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, told TPM.

Private insurance market would be thrown into chaos by a straight repeal bill and premiums would be hiked sky-high to account for the uncertainty. Without a mandate, only the sickest patients would pay those high premiums for health insurance, making the risk pool so unbalanced that it would send premiums soaring even higher. And thanks to population growth, more people would be uninsured than before the ACA was passed.

“Without the law’s significant subsidies or mandates, the individual market is very likely to enter a ‘death spiral,'” Rivlin warned in a Brookings report last year.

The idea is also deeply unpopular. A poll earlier this year by the Kaiser Family Foundation found that just 19 percent of the public wants Congress to pursue a “repeal and delay” strategy.

Repeal now, replace later? In March, just 19% of the public wanted Congress to take that approach https://t.co/xOSxgQSpwa #Obamacare pic.twitter.com/3rlmVUyLpG

— Kaiser Family Found (@KaiserFamFound) July 5, 2017

These dire warnings and predictions, however, have not stopped nearly every Republican in Congress from repeatedly campaigning on and voting for bills to repeal the Affordable Care Act “root and branch.” As Rep. Joe Barton (R-TX) suggested during the House’s struggle to pass a health care bill earlier this year, they did so knowing that former President Obama would prevent such a measure from ever becoming law, so they’re having a much harder time now under a President who’s ready to sign a repeal bill on sight.

“Sometimes you’re playing Fantasy Football and sometimes you’re in the real game,” he said.

Sen. Pat Toomey (R-PA) offered his own metaphor, saying lawmakers are now playing with “live ammo” and must proceed with caution.

Many senators have more bluntly stated over the past few weeks that repealing Obamacare without having a plan to replace it would be politically untenable.

“That would be bad for America,” said Sen. John McCain (R-AZ), whose state expanded Medicaid and would be hard hit by its repeal.

GOP leadership in the House and Senate are similarly wary of the idea, and Senate Majority Leader Mitch McConnell (R-KY) has indicated that he will continue his quest to craft a bill that both repeals and replaces the Affordable Care Act and can garner at least 50 Republican votes.

Rivlin cautions that this is much easier said than done, however.

“There is no Republican consensus on what to do,” she told TPM. “There is a right wing group that doesn’t want to do anything, that thinks it’s not the business of the federal government to regulate or subsidize insurance markets. They’d be very happy just to repeal and not replace. But then there’s the more moderate wing of the Republican pParty that is very worried that a lot of people will lose insurance and that it’ll be blamed on the Republicans.”

If Republicans want “a good legacy” on health care, she said, “they have to abandon this reconciliation strategy and begin to work with the Democrats.”