EDITORIAL: GOP’s risky rush to repeal Obamacare

Jan. 18--After seven years, and nearly 60 votes, Republicans in Congress are on the verge of killing Obamacare. But they can't say what comes next.

The steady drumbeat of "repeal and replace" has given way to repeal and, well, hope something else comes along.

So far, congressional Republicans and President-elect Donald Trump have offered only assurances that they will come up with something.

If they race ahead without a replacement, the potential upheaval should frighten even the staunchest critics of the Affordable Care Act.

At least 18 million people -- that's one in every 17 Americans -- would lose their health insurance within the first year if Republicans push forward with plans to repeal the Affordable Care Act without enacting a replacement, according to a report issued Tuesday by the nonpartisan Congressional Budget Office.

Within a decade, the report said, the number of people without health insurance would grow to 32 million, and premiums for individual policies would double.

The CBO forecast is based on GOP-sponsored legislation passed by Congress last year and vetoed by President Barack Obama.

Few states have as much at stake as California, where the uninsured rate has fallen to 8.6 percent from nearly 19 percent before the Affordable Care Act was enacted.

In the three years since the law took full effect, 1.2 million people have purchased private health insurance policies through Covered California, the state's insurance exchange. The average out-of-pocket cost for monthly premiums, according to a study published in Health Affairs, is $156 a month after Obamacare subsidies.

Also at stake is Medi-Cal coverage for 3.7 million people who qualified under Obamacare's expanded eligibility requirements. The federal government covers 90 percent of the cost.

Here in Sonoma County, nearly 56,000 people have private polices or Medi-Cal coverage as a result of the Affordable Care Act.

The financial underpinnings of Obamacare are the requirement to have health insurance and the subsidies that make it affordable, but the repercussions of repeal and delay extend beyond the millions of people who would lose their health insurance.

Hospitals, which are legally required to treat people whether they are insured or not, could expect renewed financial pressures from providing uncompensated care. Expanded access to Medicaid, which 31 states adopted, has provided a new revenue stream for rural hospitals and community health clinics.

It's likely that congressional Republicans will spare some popular provisions of the Affordable Care Act, including the guarantee that people won't be denied coverage for a pre-existing condition. Without the individual mandate to prevent people from doing without coverage until they become ill, insurers will be faced with losses that inevitably will be made up by raising premiums for everyone else.

These aren't insignificant concerns -- and there aren't any ready alternatives. That's the primary reason that Republicans haven't settled on a workable alternative to the Affordable Care Act.

Obamacare hasn't delivered everything it promised, but Americans aren't clamoring to give up their newly gained health insurance. Indeed, public opinion polls show that the vast majority of people who favor repeal want a replacement ready first, and they have been led to believe a replacement will cost less and provide better coverage than Obamacare.

We doubt that's possible. If there is such a plan, we'll support it.

Until they can present a replacement, Republicans should remember an old medical maxim: First, do no harm.

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(c)2017 The Press Democrat (Santa Rosa, Calif.)

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