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Without ACA, how many sick people will die?

Written by Diane Archer

Before people began getting health insurance under the Affordable Care Act (ACA), the Commonwealth Fund projected that as many as 84,000 people were dying each year because they lacked access to care. In fact, the Commonwealth Fund ranked the U.S. at the bottom of its list of wealthy nations on preventable deaths–96 for every 100,000 people in 2006-07. With health care costs continuing to rise way faster than inflation, we need to consider how many sick people will die after the Republican leadership repeals the ACA?

Stat news reports that organizations representing patients with costly conditions fear that ACA repeal will undo health care protections that people in poor health need. Their particular focus is on how to keep insurers from refusing to cover people with pre-existing conditions. That’s just the tip of the iceberg.

What’s likely to happen once the ACA is repealed? It wouldn’t be surprising if the Republicans allowed insurers to revert to their old ways: If so, insurers will sell expensive policies that leave people with inadequate coverage when they need costly health care and will likely deny coverage to people with costly health care needs or charge exorbitant premiums, very high deductibles and/or very high copays.

Here’s what people without employer coverage and not yet eligible for Medicare should likely expect from commercial insurers:

  • Coverage will be unavailable to many people with costly conditions. The Republican leadership has no plan to mandate that everyone have health insurance coverage. As a result, to save money, many young and relatively healthy people will likely take a gamble and go without health insurance, driving up health care costs for everyone else and inevitably leading insurers to impose huge cost-sharing responsibilities on people with pre-existing conditions. The Republican leadership is considering a plan that would require insurers to cover people who are switching out of one health plan to another, but that’s of little help if the coverage is unaffordable or inadequate.
  • Coverage will be unaffordable for many people. The Republican leadership does not want to provide subsidies to help offset premium costs for people with incomes under 400 percent of the Federal Poverty Level as the ACA does. Nor do Republicans want to regulate prices or provide automatic coverage to everyone in the country through a tax system that covers most of the cost of health care, as Medicare does for people over 65 and people with disabilities. Moreover, Republicans don’t want to limit the amount insurers can charge people through a cap on their administrative costs and profits, as the ACA does. Since commercial insurers are unable to rein in costs and aim to deliver their shareholders as high profits as possible, we can expect them to impose far higher cost-sharing on their enrollees than they do today.
  • Coverage will be inadequate for many people with costly conditions. Even if people can get coverage, people who need a significant amount of health care are likely to find their health plans don’t meet their needs. The Republican leadership is unlikely to mandate that health plans cover essential benefits, or that health plans cover as much care as people need, or that health plans impose a cap on out-of-pocket costs, as the ACA does. Without these mandates, health plans are likely to do what they did prior to the ACA–sell policies that offer only limited coverage, leaving people with costly conditions to forego needed care or pushing them into medical debt and often bankruptcy.

Neither the Republican leadership nor the Democratic leadership in Congress say they approve of “death panels.” It might be time to ask our representatives the difference between a health care system that denies needed health care to its citizens and a death panel.

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