President-elect Donald Trump and congressional Republicans favor repealing major provisions of the Affordable Care Act (ACA) early in the new administration. Republicans may have enough votes from within their own party to do away with the health law’s premium and cost-sharing subsidies, individual mandate, and Medicaid expansion. But a broader repeal of the ACA’s insurance market reforms, and adoption of a replacement health care plan, may be more challenging. These steps need bipartisan support for passage and require Republicans to resolve ongoing internal differences regarding what a replacement law should look like; they may do so, but haven’t yet.
With the substance of an alternative plan up in the air, uncertainty has grown over when the law might be replaced. Republican leaders have suggested Congress should repeal parts of the ACA now and leave the details of replacement until later. But “repeal and delay” has drawn criticism from stakeholders and policy experts who point out the strategy is likely to cause significant harm to insurance markets and consumers long before a replacement plan materializes, and a growing number of lawmakers have expressed discomfort about the proposal.
What happens if Congress and the new president push ahead with partial repeal without securing support for a replacement? The resulting regulatory landscape would look like what several states had in place prior to the ACA. Their experiences were poor.
HENRY KOTULA 