The Affordable Care Act’s days are numbered.
Congress has already started efforts to repeal the 2010 legislation and come up with an alternative. On Monday, two Republican senators introduced a proposal they called an “Obamacare replacement plan.”
On Sunday, one of President Trump’s advisors said the administration plans to turn control of the federal Medicaid program to the states.
This all followed President Donald Trump’s signing of an executive order on Friday, directing federal agencies to “minimize the economic burden” of the Obamacare health law.
So, what will happen when the dust clears?
Experts say it depends on what Congress and the president come up with as a replacement.
The predictions range from chaos as tens of millions of people lose their insurance coverage, to an efficient, affordable healthcare system that’s overseen at the state level.
Last week, the Congressional Budget Office (CBO) released a report that stated what their analysts believe could happen in the next decade.
For the study, the CBO researchers went on the assumption the Affordable Care Act (ACA) would be completely repealed and replaced with something similar to H.R.3762, a Republican-sponsored bill that was approved by Congress in 2015 but vetoed by then-President Barack Obama.
The CBO report predicts that 18 million people would lose insurance coverage. Of that group, they said 10 million would be people who bought insurance though the ACA marketplace. Another 5 million would be Medicaid recipients, and the final 3 million would be people who would lose employer-based insurance.
The analysts added that once government and Medicaid subsidies were eliminated, 27 million would become uninsured.
They predicted that 32 million people who now have insurance would lose their coverage by 2026.
The CBO report also predicted insurance premiums would rise initially by 25 percent for policies purchased by individuals.
That would increase to a 50 percent hike once subsidies are eliminated and a 100 percent jump by 2026.
They also forecast that half of the U.S. population will live in areas without a marketplace insurance setup. That will increase to 75 percent by 2026.
Many Democratic leaders have made similar predictions.
On Monday, House Minority Leader Nancy Pelosi (D-San Francisco) released a statement, saying the Republican actions will take seniors and working families “from affordable care to chaos.”
Others aren’t as sure.
Kurt Mosley, vice president of strategic alliances for Merritt Hawkins healthcare consultants, said the CBO is less bipartisan than it used to be.
He noted the agency made some rosy predictions about the success of Obamacare that didn’t quite come true.
“Lately, they’ve been more wrong than right,” he told Healthline.
What to look for
Experts like Mosley said there are several key components that will determine whether the nation’s healthcare system succeeds or not.
The first is the ACA provision of requiring insurance companies to provide coverage for people with preexisting medical conditions.
President Trump and other Republicans leaders have said they want to keep that requirement.
That may end up creating high-risk pools where people with preexisting conditions can get insurance, but at higher costs.
On the other hand, the ACA’s mandate that people must have insurance coverage or face financial penalties appears to be headed for the scrap heap.
Some experts say that provision could actually be done away with under the executive order President Trump signed on Friday.
There’s also the “employer mandate” that requires companies to provide certain minimum healthcare coverage. That also seems unlikely to survive.
Mosley added it will be important for new healthcare laws to retain the provision that allows young adults between the ages of 18 and 25 to stay on their parents’ healthcare plans.
He noted that without the individual mandate it will be important to have incentives for younger, healthier people to buy insurance.
He also thinks it’s crucial that insurance companies be allowed to sell policies across state lines, something they can’t do in ACA marketplaces.
“We need to get insurance companies to play ball,” Mosley said.
What may eventually happen is what happened last year in Kentucky.
That state elected a governor who promised to get rid of Obamacare. When it was all said and done, Kentucky crafted a healthcare program with a new name that had most of the provisions of the ACA.