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Opinion: Health Crisis Looms if Obamacare is Repealed Before Replacement

Voting to repeal the ACA without detailing an alternative plan that will guarantee affordable health coverage for all Americans would be irresponsible to the extreme

NEW Milly Silva
Credit: Amanda Brown

After nearly seven years and dozens of failed attempts to repeal the Affordable Care Act (ACA), Republicans in Congress will soon get their wish. They will then own the responsibility for protecting the lives and livelihoods of countless New Jerseyans and Americans in general who currently benefit from the many popular components of the law — including the bar against discriminating against people with pre-existing conditions and the expansion of our state Medicaid program, which allows many of our poorest and most vulnerable residents to afford care.

How the Republican Congress proceeds in the next critical weeks will literally have life and death consequences for many Americans. Will they attempt to repackage and rebrand Obamacare as their own, keeping some of its most cherished elements while eliminating those deemed incompatible with conservative orthodoxy? Or will they take an ultra-right approach and gut Obamacare almost entirely, offering up health savings accounts and the idea that insurance companies be allowed to sell their products across state lines as the panaceas for healthcare reform?

Voting to repeal the ACA without detailing an alternative plan that will guarantee affordable health coverage for all Americans would be irresponsible to the extreme. Simple promises from congressional leaders that a “better” plan is in the works are not enough. They’ve had years to outline their vision for a new and improved healthcare system and still haven’t delivered a single concrete proposal. Setting into motion vast yet ambiguous changes to this industry — which accounts for nearly one-fifth of our nation’s economy — could throw our healthcare system, and hence people’s lives, into disarray, even if various elements of the repeal legislation are put on a delayed timeline. Insurance markets need stability and predictability, and the current climate is anything but.

There is undoubtedly backroom acknowledgement among top Republicans that they will have to renege on some of their healthcare promises, thus putting themselves in a no-win political situation of their own making. It is widely recognized, for example, that their pledge to maintain pre-existing condition protections is broadly incompatible with their vow to abandon the individual mandate. If only the sick and elderly choose to buy coverage, insurance costs will rapidly spiral out of control. Obamacare is indeed convoluted, but its intricacies are necessary to keeping the system working. You cannot simply toss out parts of the law you may not like, the individual mandate and its tax penalties, for example, without jeopardizing its most lauded aspects.

It is therefore critical that we tell our Congressional leaders to not make rash, politically-motivated decisions. We must insist that whatever ACA repeal the new Congress puts forth is accompanied simultaneously by a replacement plan that meets the same overarching goal of the Affordable Care Act — this is, ensuring that quality health coverage be made available to everyone, regardless of existing medical conditions and financial circumstances.

Whatever comes after Obamacare must contain three major pillars: protecting against unfair insurance discrimination (whether on the basis of pre-existing conditions, disability, age, gender, or other patient characteristics); preserving Medicaid expansion; and maintaining the health insurance of those who purchased it through the marketplace. If these principles are not kept, many New Jersey families could face catastrophic financial hardship or worsening health problems.

The dangers posed to New Jersey by an abrupt repeal of Obamacare are many. A recent report by the Kaiser Family Foundation found that nearly one-quarter of our state’s non-elderly population, about 1.2 million people, have pre-existing medical conditions that would likely preclude them from being able to purchase private coverage if we were to revert to the pre-ACA insurance market rules.

Though it may not be perfect, the ACA thus far has served New Jersey well. According to U.S. Census data from 2013 to 2015, the number of uninsured New Jerseyans dropped significantly, from 13.2 percent to 8.7 percent. Over this same period, the number of uninsured New Jersey children in families earning below 200 percent of the federal poverty line (roughly $48,000 a year for a family of four) declined by more than a third, from 70,000 children to 45,000 children. The Department of Health and Human Services (HHS) estimates that 59,000 young adults in New Jersey have benefitted from the ACA rule mandating that insurance companies allow children to stay on their parents’ plan until age 26. Over 4 million New Jerseyans of all ages benefit from free preventative care, including flu shots and cancer screenings, that health plans must offer under ACA guidelines. All this progress is under threat of being reversed.

A recent analysis by New Jersey Policy Perspective (NJPP) determined that New Jersey will be hit harder than most other states if the Medicaid expansion is repealed. The study found that approximately 10 percent of non-elderly adults in New Jersey, over half a million people, would lose their health coverage. This number is so high because far more people enrolled in expanded Medicaid than was initially anticipated — a signal of just how necessary this program is.

The New Jerseyans at risk of losing Medicaid coverage are not mere statistics. They are real people whose health and productivity are essential to the wellbeing of our state and its residents. For example, the NJPP report cites U.S. Census data showing that there are 13,924 nursing home and home healthcare workers who receive Medicaid. These are women and men who selflessly provide critical care to our parents and our grandparents in their twilight years. Yet despite their vital work, they earn so little that they are unable to afford healthcare for themselves outside of our Medicaid program. To jeopardize health insurance for these essential workers would be devastating not only for them, but also for their patients, who depend on having healthy, committed caregivers.

As plans to repeal the Affordable Care Act are being drawn up, it is crucial that Americans make their voices heard by calling their legislators on the phone this week. We must demand that a new, comprehensive healthcare plan be developed before any action is taken against the ACA that would result in people losing access to any healthcare services now or in the future. This is not about politics or partisan gamesmanship; it is literally a life and death issue for New Jersey families. No one should ever be forced to choose between getting the healthcare they need or facing financial ruin.

Milly Silva is executive vice president of 1199SEIU United Healthcare Workers East, the largest union of healthcare workers in the United States.

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