What Could Repeal or Reform of Affordable Care Act Mean for Americans?

PROVIDENCE, R.I., Dec. 5 -- Brown University issued the following news release:

Ten Brown faculty -- experts in medicine, public health, public policy, political science, health services and sociology -- have assessed the implications of a potential repeal or reform of the Patient Protection and Affordable Care Act (ACA) in commentaries available through the School of Public Health, the Watson Institute for International and Public Affairs and the School of Professional Studies Executive Master of Healthcare Leadership program (EMHL).

The commentaries consider questions that arise now that President-elect Donald J. Trump and congressional Republicans have signaled their intention to repeal or reform the ACA, the law passed in 2010 that was designed to increase the number of Americans covered by health insurance and decrease the cost of health care.

Two key provisions of the ACA are the individual mandate, which requires most Americans to maintain "minimum essential" health insurance coverage, and the expansion of Medicaid, which increased the number of individuals that states must cover. An estimated 20 million citizens have gained health insurance coverage through the ACA. Faculty assess why the ACA is vulnerable, who will feel the impact of the repeal most strongly, what repeal means for certain types of patients and their care and what the consequences of a repeal may be on Medicare and other institutions, among other concerns.

Jim Austin, a faculty member in the Brown EMHL program and principal at Decision Strategies International, discussed two areas he hopes the new administration and Congress tackle in seeking to reform or replace the ACA: high deductibles that lead patients to avoid paying for needed care and force hospitals to decide between writing off the loss or denying care, and insurance availability, particularly in rural areas where individual insurers are few.

Margot Jackson, Watson Institute Faculty Fellow and associate professor of sociology, noted that "the strongest effects of an Obamacare repeal would perhaps be on adults living in Republican states," because that group has "been most likely to gain insurance via Obamacare because they were previously less likely to qualify for Medicaid" or other state programs for individuals with low incomes or pre-existing conditions."

But the ACA's beneficiaries, according to Eric Patashnik, the Julis-Rabinowitz Professor of Public Policy and professor of political science at Watson, "are struggling to pay rising deductibles at a time when they have seen their wages stagnate or decline," and the program is "not perceived as a broad middle-class entitlement." He predicted that repealing "the subsidies and mandate penalties contained in the ACA while retaining the ban on the exclusion of preexisting conditions and other reforms could cause insurers to leave the marketplace."

Vincent Mor, the Florence Pirce Grant University Professor and professor of health services, policy and practice, looked at ACA-related institutes that may be affected, identifying the Patient Oriented Outcomes Research Institute of the National Institutes of Health as susceptible to defunding because of Republican discomfort with policy-oriented research.

Other faculty experts considered potential health inequalities, how the repeal would affect persons living with HIV, the prospects for women's health care and what might happen to Medicaid. The full commentaries are available at School of Public Health, the Watson Institute for International and Public Affairs and the School of Professional Studies sites.

The commentators are:

Jim Austin, faculty member in the Brown Executive Master of Healthcare Leadership program and principal at Decision Strategies International.

Sandra Ferretti, program advisor at Brown's School of Professional Studies and former consultant to the state of Rhode Island for the Rhode Island Health Insurance Exchange.

Margot Jackson, Watson Institute Faculty Fellow and associate professor of sociology.

Vincent Mor, the Florence Pirce Grant University professor and professor of health services, policy and practice.

Dr. Heather Marshall, Southwest Associate Regional Medical Director at Island Medical Management.

Rose McDermott, the David and Marianna Fisher University Professor of International Relations at the Watson Institute.

Eric Patashnik, the Julis-Rabinowitz Professor of Public Policy and professor of political science at the Watson Institute.

Dr. Amal Trivedi, associate professor of health services, policy and practice, associate professor of medicine.

Anya Radar Wallack, Ph.D, program manager, Brown's Center for Evidence Synthesis in Health.

Dr. Ira B. Wilson, professor of health services, policy and practice, professor of medicine, chair of the Department of Health Services, Policy and Practice.

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