Republicans still don’t have an official plan to replace Obamacare. You know that already. What you may not realize, though, is that they don’t have a plan to fully repeal Obamacare, either. Because the GOP only controls 52 seats in the Senate, party leaders are planning to partially scrap the law using the budget reconciliation process, which prevents filibusters on tax and spending legislation, but can’t be used to change regulations. As a result, Republicans have a clear path to ending Obamacare’s Medicaid expansion, insurance subsidies, and even the individual mandate (it’s a tax, after all). But without a filibuster-proof 60 votes, they can’t do much about the law’s rules that bar insurers from discriminating against patients with pre-existing conditions and require health plans to cover certain essential benefits.
What would happen if they did that and then failed to replace the law? The Congressional Budget Office and the Joint Committee on Taxation have released a new analysis exploring that question, based on the reconciliation bill that Republicans passed about a year ago as a dry run for Obamacare repeal (and that President Obama vetoed). While the report says its estimates are a bit “uncertain”—modeling massive changes to the health care market is hard to do—they also aren’t pretty. The number of uninsured Americans would rise by about 18 million in the first year after passage. Once the Medicaid expansion and subsidies were gone, the number would hit 27 million, before eventually hitting 32 million in 2026.
One reason the uninsured rate would rise so quickly, according to the report, is that the repeal bill Republicans voted for would immediately end the individual mandate’s tax penalties, which are designed to force Americans to buy coverage. As a result, many healthy Americans would choose to go uninsured. That would leave behind a smaller pool of customers full of sicker patients, forcing insurers to raise their prices—the CBO and JCT predict premiums would rise 20 to 25 percent. Meanwhile, many carriers would probably gaze upon this impending wreck and pull out of the individual market altogether. “As a consequence, roughly 10 percent of the population would be living in an area that had no insurer participating,” the CBO and JCT conclude.
According to the report, the uninsured rate really begins to swell two years after passage, when Obamacare’s Medicaid expansion and insurance subsidies finally sunset. Here’s the report’s final tally of the carnage:
The estimated increase of 32 million people without coverage in 2026 is the net result of roughly 23 million fewer with coverage in the nongroup market and 19 million fewer with coverage under Medicaid, partially offset by an increase of about 11 million people covered by employment-based insurance. By CBO and JCT’s estimates, 59 million people under age 65 would be uninsured in 2026 (compared with 28 million under current law), representing 21 percent of people under age 65. By 2026, fewer than 2 million people would be enrolled in the nongroup market, CBO and JCT estimate.
It is unclear how closely the repeal bill Congress is now concocting will follow the timeline it settled on in last year’s legislation. But one takeaway from all of this is that Republicans in Congress would be absolutely insane to repeal the individual mandate before dealing with other pieces of the law, since that could trigger the sort of immediate market collapse that the “repeal and delay” strategy is meant to prevent in the first place. More broadly, it shows the extent of the disaster that could ensue if the GOP passes partial repeal without a clear path to replacement. They’ll be setting a time bomb without a kill switch. Who wants to bet that will end well?