Bill Overview
Title: Responsible Path to Full Obamacare Repeal Act
Description: This bill repeals the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, effective at the beginning of FY2023. Provisions of law amended by those acts are restored.
Sponsors: Rep. Biggs, Andy [R-AZ-5]
Target Audience
Population: People insured or affected by the ACA
Estimated Size: 31000000
- The Affordable Care Act (ACA) expanded Medicaid coverage and created insurance marketplaces, leading to millions gaining health insurance.
- As of recent data, approximately 31 million people have health insurance through the ACA, including through marketplace plans and Medicaid expansions.
- Repealing the ACA without a replacement could result in millions losing health insurance coverage.
- The ACA also included protections for people with preexisting conditions, impacting a broad segment of the population.
Reasoning
- The budget for this policy is limited to $25 billion in year 1 and $289 billion over 10 years, which must be allocated for transitional support or new programs to replace ACA structures. As such, only a portion of the 31 million ACA-affected individuals will receive immediate replacement support or transitional insurance options, potentially causing differential impacts based on socioeconomic status and geographic location.
- Given that the ACA repeal would remove coverage for preexisting conditions, subsidies for insurance, and Medicaid expansion, it is anticipated that individuals with low income, the chronically ill, and those in professions with unstable employment may experience significant wellbeing declines without alternative provisions.
- Interviews should reflect diverse scenarios including high impact with immediate negative consequences, as well as scenarios with no immediate impact for those who have eschewed ACA benefits or have alternative coverage strategies.
- Cost considerations suggest any replacement measures might prioritize the most vulnerable, but budget constraints hint at gaps in coverage or support, leading to medium to high impact on wellbeing for many without targeted interventions.
Simulated Interviews
Freelance Graphic Designer (New York, NY)
Age: 27 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 8/20
Statement of Opinion:
- Without the ACA, my insurance premiums could skyrocket.
- I'm worried about losing coverage for preexisting conditions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 6 |
| Year 2 | 4 | 6 |
| Year 3 | 4 | 7 |
| Year 5 | 3 | 7 |
| Year 10 | 2 | 7 |
| Year 20 | 2 | 8 |
Retired (Tulsa, OK)
Age: 62 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- I rely on prescription drug discounts.
- Repealing ACA might increase my healthcare costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 8 |
| Year 2 | 6 | 8 |
| Year 3 | 5 | 8 |
| Year 5 | 5 | 8 |
| Year 10 | 4 | 8 |
| Year 20 | 3 | 8 |
Teacher (Miami, FL)
Age: 45 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- I worry about losing preexisting condition coverage.
- Fortunately, my husband's job offers good benefits.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 6 | 7 |
| Year 10 | 6 | 7 |
| Year 20 | 5 | 7 |
Small Business Owner (Seattle, WA)
Age: 33 | Gender: other
Wellbeing Before Policy: 8
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- The repeal could make marketplace plans unaffordable.
- Employees worry about losing coverage.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 8 |
| Year 2 | 5 | 8 |
| Year 3 | 5 | 8 |
| Year 5 | 4 | 8 |
| Year 10 | 3 | 8 |
| Year 20 | 3 | 8 |
Restaurant Manager (Atlanta, GA)
Age: 39 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 9/20
Statement of Opinion:
- I can't afford private insurance without Medicaid.
- This policy would leave me uninsured.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 5 |
| Year 2 | 3 | 6 |
| Year 3 | 2 | 6 |
| Year 5 | 2 | 7 |
| Year 10 | 1 | 7 |
| Year 20 | 1 | 8 |
Graduate Student (Los Angeles, CA)
Age: 24 | Gender: female
Wellbeing Before Policy: 9
Duration of Impact: 4.0 years
Commonness: 6/20
Statement of Opinion:
- Staying on my parents' insurance has helped me financially.
- I'm worried about what happens if this option goes away.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 9 |
| Year 2 | 7 | 9 |
| Year 3 | 6 | 9 |
| Year 5 | 6 | 9 |
| Year 10 | 5 | 9 |
| Year 20 | 5 | 9 |
Engineer (Houston, TX)
Age: 51 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 7/20
Statement of Opinion:
- The repeal doesn't personally affect my current coverage.
- I am concerned for those who rely on the ACA.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Unemployed (Des Moines, IA)
Age: 58 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- I'm terrified of losing my insurance.
- Without ACA, getting prescriptions will be hard.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 6 |
| Year 2 | 3 | 6 |
| Year 3 | 3 | 6 |
| Year 5 | 2 | 7 |
| Year 10 | 1 | 8 |
| Year 20 | 1 | 8 |
Construction Worker (Phoenix, AZ)
Age: 42 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- I really depend on Medicaid expansion.
- Repealing ACA would mean huge medical bills for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 3 | 5 |
| Year 2 | 3 | 6 |
| Year 3 | 2 | 6 |
| Year 5 | 2 | 7 |
| Year 10 | 1 | 8 |
| Year 20 | 1 | 8 |
Retired (Boston, MA)
Age: 74 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 10/20
Statement of Opinion:
- I am not directly affected by ACA changes.
- I am worried about what this means for my grandchildren.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 6 | 7 |
| Year 10 | 6 | 7 |
| Year 20 | 6 | 7 |
Cost Estimates
Year 1: $25000000000 (Low: $20000000000, High: $30000000000)
Year 2: $26000000000 (Low: $21000000000, High: $31000000000)
Year 3: $27000000000 (Low: $22000000000, High: $32000000000)
Year 5: $29000000000 (Low: $23000000000, High: $35000000000)
Year 10: $32000000000 (Low: $27000000000, High: $37000000000)
Year 100: $40000000000 (Low: $35000000000, High: $45000000000)
Key Considerations
- A significant portion of the U.S. population is currently insured under the ACA, and repeal may lead to an increase in the uninsured rate.
- Medicaid expansion and premium subsidies have reduced uncompensated care costs that hospitals face.
- Repeal could shift costs from federal subsidies to state and local governments or private entities.
- Repealing the ACA would also revoke consumer protections such as coverage for pre-existing conditions.