When they destroy stuff, they really mean it, those Republicans. A new study from the Urban Institute, based on the repeal bill passed by Congress earlier this year (it's all we've got to go by, since they haven't come up with anything else), finds that the plan would end insurance for more than 30 million people.
Here's just a snapshot of the wreckage.
- The number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people (103 percent). The share of nonelderly people without insurance would increase from 11 percent to 21 percent, a higher rate of uninsurance than before the ACA because of the disruption to the nongroup insurance market.
- Of the 29.8 million newly uninsured, 22.5 million people would become uninsured as a result of eliminating the premium tax credits, the Medicaid expansion, and the individual mandate. The additional 7.3 million people would become uninsured because of the near collapse of the nongroup insurance market.
- Eighty-two percent of the people becoming uninsured would be in working families, 38 percent would be ages 18 to 34, and 56 percent would be non-Hispanic whites. Eighty percent of adults becoming uninsured would not have college degrees.
- There would be 12.9 million fewer people with Medicaid or CHIP coverage in 2019.
What would happen is that immediate repeal would take the subsidies away from everyone, they wouldn't be able to afford it, and only the sickest people would stay enrolled. The end of the mandate to buy insurance would mean fewer would sign up in the first place. The mandate on insurers to keep people with pre-existing conditions would still stand, and these factors combined would cause the collapse of the individual market. It would start immediately, Urban predicts, with 4.3 million dropping their coverage and becoming uninsured next year. But that's not all!
This scenario does not just move the country back to the situation before the ACA. It moves the country to a situation with higher uninsurance rates than before the ACA. To replace the ACA after reconciliation with new policies designed to increase insurance coverage, the federal government would have to raise new taxes, substantially cut spending, or increase the deficit.
You know that Republicans aren't going to be raising taxes and while they don't really care about the deficit, they'll use it as a handy excuse to cut spending. They sure don't have any qualms about doing that, as long as it's not for defense programs.
Maybe, just maybe, enough Republicans will understand this looming disaster to avert it. And maybe, if they're serious enough about fixing it, Democrats could work with them in good faith on reforms. But they're not going to lift one little damned finger to help them break it, to be theirs to bail them out after the fact.