The U.S. Senate is scheduled to vote Tuesday on the fate of the Affordable Care Act (ACA).
What exactly the senators will be voting on isn’t certain at this point.
Will it be a straight repeal of the Obamacare law, or will it be a repeal with a replacement plan attached?
Meanwhile, President Donald Trump has suggested that Republicans just allow the Affordable Care Act to fail.
The president has even hinted he might nudge that failure along by not providing subsidies for insurance premiums and not promoting the plan during the next sign-up period.
At this juncture, neither approach appears to have enough votes to pass.
While the future of Obamacare floats in the air, millions of healthcare consumers may worry about what could happen to them and their families.
What indeed would happen if the ACA simply disappeared?
The forecasts vary widely, depending on who you ask.
A Congressional Budget Office (CBO) report issued last week concluded that 17 million people would lose insurance coverage the first year after the ACA is dismantled.
CBO analysts also predicted insurance premiums would jump by 25 percent during that year.
They also said 32 million people would lose insurance coverage after a decade, and insurance premiums would double.
The report did state the federal deficit would be cut by $473 billion over that decade if Obamacare were repealed.
Shawn Martin, senior vice president for advocacy, practice enhancement, and policy at the American Academy of Family Physicians, thinks those predictions aren’t too far off.
Martin told Healthline he believes a large number of people would lose insurance under a repeal-only of the ACA.
A major reason for the increase in uninsured would be the pullback of the Medicaid expansionunder Obamacare.
Premiums and deductibles, Martin said, would also likely rise. This would be particularly true for people with preexisting health conditions.
Martin added that there would be an impact on doctors because they would have fewer insured patients.
Martin said the impact would be similar if Republicans simply let Obamacare fail. The only difference might be that it would take longer to feel the pain.
“It would be a slow bleed, and it would hurt the most vulnerable first,” said Martin.
Kurt Mosley, vice president of strategic alliances at Merritt Hawkins health consultants, doesn’t see things quite as drastically, but he does believe there would be significant impacts under a repeal.
He notes the predictions are “all over the place,” from 30 million losing coverage to 4 million being suddenly without health insurance.
He said the state health exchanges might come under some strain. Minimum requirements for insurance coverage would go away. So would the mandate that everybody must have insurance.
Medicaid expansion, he noted, is still needed for children as well as for opioid addiction treatment programs.
“All that would go away,” he told Healthline.
Mosley acknowledged that under Obamacare, healthcare costs have gone up, as have deductibles and premiums.
In addition, there are fewer choices for healthcare consumers in many places.
Nonetheless, polls show a majority of consumers do not want the ACA to be eliminated. They prefer it be modified and fixed.
“Once you give people a taste of something, if you take it away, that’s a problem,” Mosley said.
If you let Obamacare crash without a replacement plan, that too creates problems.
“If you let it fail, you leave people without insurance,” Mosley said.
Everything will be fine
There are those who predict that the nation’s healthcare system will improve quickly and dramatically if the ACA is dissolved.
One of them is Twila Brase, the president and co-founder of the Citizens’ Council for Health Freedom.
She supports a full repeal of Obamacare without any replacement plan.
Her reasoning is simple. The federal government should not be overseeing healthcare.
“The problem we have is the federal government got involved in the first place,” Brase told Healthline.
If the ACA were to disappear, Brase predicted, the states would take over the insurance marketplaces as well as Medicaid.
Brase said insurance companies would then offer a variety of plans, including catastrophic health insurance coverage for younger and healthier people.
All this, she believes, would decrease costs, increase choice, and provide easier access to care.
“The states and individuals are supposed to be in charge of healthcare,” she said.
Brase said the “gorilla in the room” is Medicare, the health program for people 65 years and older.
She said this system is driving the nation’s healthcare system and needs to be reformed. That includes letting people opt out of the program.
Brase dismissed the CBO predictions, saying that office was way off on its forecast for Obamacare enrollment.
Brase said allowing the ACA to collapse would have the same positive effects because it would force states to take over.
“Obamacare is failing and if it does, that presents an opportunity for states,” she said.
Brase acknowledged there might be some short-term pain for some consumers but said the changes would be worth it in the end.
“This pain would take this country to where it belongs,” she said.
Dr. Elaina George, a board-certified otolaryngologist and author of “Big Medicine: The Cost of Corporate Control and How Doctors and Patients Working Together Can Rebuild a Better System,” agrees along the same basic lines.
She also supports a repeal of Obamacare but believes a two-year phase-out period is required, as is having a replacement plan.
“Just uprooting the system would be a problem,” George told Healthline.
She said under a repeal, insurance companies would be encouraged to create a variety of coverage plans.
More insurance companies would also join the pool. Right now, George noted, only five insurance companies are participating in the state marketplaces.
George also believes the free market would drive down costs.
She dismisses CBO predictions, saying “they were wrong about Obamacare, too.”
George does acknowledge that people with preexisting health conditions might have trouble finding insurance and certainly would pay more for it.
But, she said, that’s not necessarily a bad thing.
“They should pay a little more,” she said. “They use the system more.”
Overall, George said, a repeal and replace plan would put power back in the hands of consumers.
“People will have the ability to be healthcare consumers,” she said.