What happens if health care is repealed

It also required that preventive services like vaccinations or wellness visits be provided without any out-of-pocket costs. Equally important, the ACA eliminated annual and lifetime coverage limits that insurers commonly imposed.

These restrictions often confused consumers and left them on the hook for large charges when they got sick and exceeded the limits. Each year, about 5 million of them experience a coverage gap. Adding further costs, seniors, like all other Americans, would also face more out-of-pocket payments for preventive services. Early retirees too young to qualify for Medicare will find it virtually impossible to obtain insurance coverage on their own.

Those with pre-existing conditions would be turned down by the insurance carrier. Most others would face prohibitively high premiums due to their age. Eliminating the ACA would also expunge the increase in payroll taxes for high-income earners , which stabilized the Medicare trust fund.

This raises new concerns about the long-term viability of the entire program. While the public is focused on the current pandemic, an opioid epidemic has ravaged the nation for years.

The effects are enormous and permeate American communities. The ACA has allowed hundreds of thousands of Americans to get crucial treatment by providing them with access to health insurance. As mentioned before, it also eliminated annual and lifetime limits on these benefits.

And 1. Map is colored to illustrate relative impact by showing the percent increase in the number of uninsured. Losing health insurance would also be devastating for family finances and hurt the economy. By helping pick up the tab for individual insurance and expanding coverage on Medicaid, the ACA has helped millions of Americans afford their care.

With nearly 9 in 10 older adults taking prescription drug medication—and 1 in 4 seniors already struggling to afford their medications—reopening the coverage gap would have devastating consequences. Before the ACA, individual market plans were not required to cover prescription drugs. Without the ACA, insurers could exclude all drugs or entire classes of drugs, leaving some patients with high out-of-pocket costs and others unable to afford the treatments they need during the current public health crisis.

Medicaid expansion narrowed racial gaps in coverage —which is particularly important as the pandemic continues to hit communities of color most harshly—and is critical for both preventive and curative care.

States such as Ohio, Pennsylvania, Michigan, West Virginia, California, and Louisiana continue to battle the pandemic, each with hundreds of thousands enrolled in Medicaid expansion. The sudden elimination would be catastrophic for public health, likely preventing millions of newly uninsured people from accessing treatment, threatening their own well-being and compounding the spread of the virus.

Furthermore, low-income families currently benefiting from Medicaid expansion would be at grave risk of financial catastrophe and more likely to take out debt in the event of a health emergency if they were to lose their coverage. Due to systemic racism, sexism, and poverty, Black women and Latinas disproportionately rely upon the benefits the Medicaid program provides, including covering nearly half of all births in the United States.

Eliminating this safety net is particularly concerning given Black women were already facing a maternal health crisis before the COVID pandemic devastated their community. Additionally, ACA repeal would reverse the gains from Medicaid expansion on the employment of people with disabilities—which is typically abysmally low—and would harm a community that is already disproportionately poor.

Finally, research shows that Medicaid expansion has also enhanced public safety by helping low-income working-age adults transition from incarceration, saving communities tens of billions of dollars. Stripping coverage from more than 20 million Americans at any point in time would be terribly cruel, but to do so during a deadly pandemic would be catastrophic on individual, community, and national levels. During this economic crisis and public health emergency, the president should be following the guidance of public health experts and trying to increase access to affordable health care.

The Trump administration should use the energy and speed they are applying to this callous endeavor to slow the spread of the coronavirus and help all Americans gain health care coverage to protect them during this unprecedented time. Maura Calsyn is the managing director of Health Policy at the Center. Colin Seeberger is a director of Media Relations at the Center. To find the latest CAP resources on the coronavirus, visit our coronavirus resource page.

Emily Gee. Charles Gaba , Emily Gee. Colin Seeberger Director, Media Relations. Peter Gordon Director, Government Affairs. Some proposals would convert Medicaid financing to a block grant to states. Under this plan, states would receive a lump sum federal payment for Medicaid, indexed to inflation. The payment is fixed regardless of enrollment. We estimated the block grants as a component of the Trump campaign platform. Under this arrangement, the federal government sets a limit on how much to reimburse states per enrollee.

Cost growth per enrollee is indexed to inflation. We estimate that under one such proposal the AHCA Medicaid enrollment would fall by nearly 10 million people by The impact becomes more pronounced over time, with Medicaid enrollment falling by nearly 14 million.

We also estimate that this change will shift costs to the states over time, as recent growth in per capita Medicaid costs exceeds the Medical Consumer Price Index, and this trend may continue. This is not an inherent effect of per capita caps, but as implemented under the AHCA, the caps would reduce funding for the Medicaid expansion population.

States could respond in several ways:. The net effect of these provisions will most likely translate into some combination of lower Medicaid enrollment and less generous coverage.

Of the various mechanisms for raising revenues in the ACA, one of the most debated has been the "Cadillac tax," scheduled to take effect in The tax would be jointly paid by employers and workers on their respective contributions.

The Cadillac tax seeks to address problems with the tax advantage for employer-sponsored insurance ESI , which allows premiums to be paid with an unlimited amount of pre-tax dollars.

The current tax break has been criticized for encouraging overly comprehensive benefits and promoting overconsumption of care. However, the Cadillac tax has also been criticized for making high-cost plans too expensive, particularly for firms with older and sicker workers, and because the flat 40 percent excise tax is not progressive, like federal income tax.

A third option that could address both sets of concerns is a cap on the tax advantage for ESI known as an "exclusion cap". Under this cap, individuals in employer plans could exclude premiums from their taxable income up to a dollar limit.

Premiums in excess of the cap would be treated as taxable income and, therefore, subject to federal and state income taxes. The same limits would apply to employers. Like the Cadillac tax, an exclusion cap addresses the problem of ESI's open-ended tax advantage, but would be more equitable because the impact is smaller for people with lower incomes.

For families in all income categories, spending for health benefits declines, but the declines are larger for the Cadillac tax than for the tax cap.

But when changes in health benefits are combined with changes in take-home pay, the differences in progressivity between the Cadillac tax and the tax cap were small. The research also suggested that employers might respond to either the Cadillac tax or the exclusion cap by reducing their health benefits for employees.

To avoid paying the 40 percent excise tax or the amount above the exclusion cap, employers may reduce the generosity of the health insurance plans that they offer. Because wages are subject to income and payroll tax, these changes would increase federal revenue.

As policymakers weigh the choices ahead, it is clear that tensions exist between many health policy goals—for example, expanding coverage versus reducing costs; targeting tax credits effectively versus incentivizing work; protecting the sickest and most expensive patients versus preserving choice among the majority of patients who may not need comprehensive coverage; and limiting the federal government's cost liability versus minimizing cost-shifting to consumers and states.

Deciding among these goals or striking a balance across them will involve political and value calculations about what the U.

The Future of U. Using COMPARE , researchers have examined the impact of many configurations of health insurance in the United States, including: maintaining the ACA with no changes repealing the law with no replacement replacing the law with a single payer system replacing the law with other measures that address coverage expansions through Medicaid and the individual market RAND research has also examined the impact of retaining the ACA while modifying key provisions, including: repealing the individual mandate modifying tax credit subsidies revising market regulations modifying Medicaid expansion Below, we summarize the impacts of these alternatives, focusing on the effect of potential changes to the ACA on the number of uninsured and consumer out-of-pocket costs.