Repealing the ACA: Millions of Lives on the Line

By Jill Zorn

Female Doctor Treating Patient Suffering With Depression

This is a very real possibility: Congress repeals the Affordable Care Act (ACA) in January and never quite gets around to replacing it.


With majorities in both the Senate and the House, Congressional Republicans are chomping at the bit to repeal major provisions of the Affordable Care Act (ACA). They are expected to use a process known as budget reconciliation, which allows them to repeal key ACA revenues and expenses. Using this process, they won’t need 60 votes in the Senate to avoid a filibuster, they will just need 51 votes in the Senate to pass a bill and a President who will sign it.

They have already done a “test drive” of an ACA budget reconciliation bill, HR 3762, which was vetoed by President Obama last year. Given that they are ready to go, most observers feel that Congress won’t waste any time and will pass something very similar in January.

Here are a few highlights from that bill, which the Congressional Budget Office says could lead to 22 million people losing their coverage:

  • Eliminates the tax credits that subsidize the purchase of health insurance in the marketplaces
  • Eliminates the Medicaid expansion that covers low income adults
  • Eliminates the individual mandate penalty, a fee imposed on people who do not get covered
  • Eliminates other fees and taxes that fund the ACA

Reflecting a hostile environment in Congress toward family planning, the budget reconciliation bill also eliminated federal funding for Planned Parenthood.

Impact on Connecticut

In Connecticut, 200,000 low income adults are covered through the Medicaid expansion. Just over 100,000 people buy health insurance through Access Health CT, Connecticut’s health insurance marketplace, and 75% of them rely on tax credit subsidies so they can afford their coverage. Facing an almost $1.5 billion budget deficit next year, it is not clear how or if the state could find the resources to keep these people covered.


Without a replacement plan in place, last year’s budget reconciliation bill, Congress delayed the Medicaid and tax credit cuts for two years, to allow time for a “smooth transition” to whatever programs would ultimately replace the ACA. Following this idea, a repeal bill passed in January 2017 is expected to include a delay until the end of 2019, after the midterm Congressional elections have passed.

But there is no guarantee that a replacement plan can be passed, as it will require 60 votes in the Senate, can be passed. Getting that kind of bipartisan consensus could take years – or could actually be impossible to achieve.

Also, as the Center for American Progress (CAP) points out, once the individual mandate penalty is gone, insurers aren’t likely to want to continue to offer insurance policies in the marketplaces. CAP explains that delay is “a fallacy”.

Even with a delayed effective date, the reconciliation bill approach would cause massive disruption and chaos in the individual market for health insurance. The complete unraveling of the market would occur by the end of 2017.


An article by Sarah Kliff of Vox, lays out some of the possible plans for replacement. As she summarizes,

If we can say one thing about most Republican plans, it is this: They are better for younger, healthy people and worse for older, sicker people. In general, conservative replacement plans offer less financial help to those who would use a lot of insurance.

Most of these plans offer far less help to lower income people, too. In other words, in this ‘through the looking glass” ACA replacement world, the people who need insurance the most, or who have lesser means to afford it, will have far more likely to become uninsured.

Another recent blog post by Georgetown’s Sabrina Corlette, points out the “insanity” contained in several of the replacement plans. Proposals like re-establishing high risk pools or promoting the purchase of insurance across state lines, touted as “the answer”, simply do not work.

Other Ways to Unravel the ACA

Finally, outside of the legislative process, the Trump administration has many other ways to unravel the ACA, including rewriting regulations, not enforcing regulations, and not appealing court decisions. Tim Jost and Nicholas Bagley two attorneys with health policy expertise, have both written about this possibility.

Fight Back

With millions of lives on the line, health advocacy organizations across the country, including Universal Health Care Foundation, are gearing up to fight back against the unconscionable actions of “Repeal and Replace”. Please join us by signing up on our website or sending us an email at

Note: It’s not just the Affordable Care Act that is at risk. A future blog will explain how Medicare and Medicaid as we know them are also very much on the firing line.

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