- Authors of a recent viewpoint published in the Journal of the American Medical Association foresee health and financial risks the uninsured patient population following a partial or complete repeal of the Affordable Care Act (ACA).
“The expanding uninsured population could encounter serious health and financial risks due to the loss of health care coverage, while the cost of health insurance premiums could increase more steeply for the insured population,” wrote Adam Eltorai, MSc, and Mahmoud Eltorai, MD.
The pair analyzed ACA repeal and replace plans unveiled by GOP leaders with the future the ACA hanging in the balance. Eltoria & Eltoria contend that a repeal and replace would affect consumer premiums prices, greatly increase the number of uninsured individuals in the country, and create financial implications for payers based on congressional estimates and current ACA statistics.
The authors cited January 2017 Congressional Budget Office (CBO) numbers requested by Senate leaders that measured changes in premium rates if a repeal and replace plan were to keep health insurance market reforms in place while repealing mandates and subsidies.
Payers have reported already experiencing significant financial backlash from selling through the ACA exchanges. Humana plans to drop out of the exchanges by 2018, along with several other major private payers such as Aetna. A partial or complete ACA repeal is likely lead more payers to follow, CBO and the Joint Committee on Taxation (JCT) found.
“In CBO and JCT’s estimation, the factors exerting upward pressure on premiums and downward pressure on enrollment in the nongroup market would lead to substantially reduced participation by insurers and enrollees in many areas,” the CBO report stated. “Prior experience in states that implemented similar nongroup market reforms without a mandate penalty or subsidies has demonstrated the potential for market destabilization.”
Additionally, Eltoria & Eltoria called attention to the CBO report and its prediction that premiums for individual policies purchased either through marketplaces or directly from insurers is projected to increase by 20 to 25 percent, with increases estimated to reach 50 percent following the elimination of Medicaid expansion and marketplace premiums expected to double by 2026.
The authors determined that the uninsured rate for Americans would increase to 18 million people if the ACA were repealed, and that the number of uninsured Americans would expect to bump up to 32 million by 2026.
By removing the exclusion of people with pre-existing conditions and providing subsidies for individuals with incomes severely below the poverty line, ACA cut the number of uninsured Americans by millions.
“With the implementation of the ACA in 2014, including the expansion of Medicaid, establishment of health insurance marketplaces, removing the exclusion of people with preexisting conditions, and providing subsidies for individuals with incomes less than 400% of the federal poverty level, the number of uninsured individuals decreased by an estimated 17 million by 2016,” the authors said.
Uninsured patient populations create large financial implications within the healthcare industry. In 2015, 53 percent of uninsured adults under the age of 65 were likely to have serious financial consequences because of medicals, compared to only 20 percent of insured adults.
As the uninsured population and medical debt rise, less providers are able to be properly compensated for services. States that received Medicaid funding noticed reductions in uncompensated care costs and medical debt. The authors claimed this trend is unlikely to continue without replacement legislation alongside an ACA repeal.
“Between January 2014 and June 2015, the 31 states that expanded Medicaid under the ACA received $79 billion in enhanced federal funding for newly eligible adults,” the authors wrote. “These states achieved net economic gains in employment, increased revenues to hospitals and physicians, decreases in uncompensated care, and savings in other state-funded programs such as corrections and behavioral health programs. Repeal of the ACA, without substitute legislation, could adversely affect this federal funding to the states.”
An ACA repeal without replacement legislation that makes comprehensive health insurance affordable to consumers will have negative consequences for a growing number of uninsured Americans.