Repeal and replace. That was and still is the Donald Trump promise for Obamacare. Congressional Republicans are ready to join in. Not that they haven't been trying for the past six years, with over 60 attempts at repeal at the congressional level, all quickly dispatched by the Obama veto pen.
Now that there is a new sheriff in town, the veto threat is gone. Repeal and replace may actually happen. What will it mean?
In my local paper, The Denver Post, is an article, written not by anyone at The Denver Post, but instead by The Associated Press, claiming that 30 million people will lose their health insurance if Obamacare is repealed. The article describes a recent study from the Urban Institute looking at the scenario of repeal only – no replacement – and predicts an increase of 30 million uninsured people over the next three years.
More specifically, the article notes that the number of uninsured would double, from about 30 to 60 million with "repeal without replacement" between now and 2019. Several points are noteworthy.
Why are there nearly 30 million people currently uninsured? Wasn't Obamacare supposed to fix this problem? Between Medicaid expansion and the individual mandate requiring everyone to purchase health insurance, there should be virtually no one still uninsured. After all, wasn't fixing the problem of the uninsured one of the justifications and goals of Obamacare? The official website says the ACA was instituted with the goals of "access, affordability, and quality in health care for Americans."
The Urban Institute study also assumes repeal only, without replacement. Sure, this is one possible scenario, but it is quite unlikely. Donald Trump, on his campaign website, is quite specific about not only repeal, but also replacement, saying, "It is not enough to simply repeal this terrible legislation." He goes farther: "[w]e have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty."
Speaker Paul Ryan released his own 37-page plan outlining what replacement might look like. So it is a bit disingenuous for the Urban Institute's study of repeal without replacement to be given such credence. It is a dubious study to perform, taken with a large grain of salt, since neither Trump nor congressional Republicans are entertaining this scenario.
Research studies should also be viewed through the lens of who is performing the research and whether he has a particular agenda. This is especially in climate change studies, where funding and political biases influence study conclusions.
The original AP article describes "the nonpartisan Urban Institute." Are they? The L.A. Times and Washington Post notethat the Urban Institute is a "leading liberal think tank." Seems the AP didn't do their research. Regardless of the political leanings of the Urban Institute, their intrinsic biases should be mentioned when describing their research studies.
Going a step farther, how many of the Obamacare enrollees will actually lose their insurance under a repeal and replace scenario?
Who best to answer this than Jonathan Gruber, the MIT professor and architect of Obamacare? In case you've forgotten him, he is the one who praised "the stupidity of the American voter" for helping pass Obamacare into law.
Gruber has a new study saying, "Roughly two-thirds of new Medicaid enrollees in 2014 were eligible for the program under previous state eligibility criteria – meaning that they were not made eligible by the ACA." This means that it wasn't Obamacare that made these new enrollees eligible; they just, for whatever reason, never signed up for a program they were entitled to all along.
Take this a step farther with analysis from the Heritage Foundation, which for full disclosure is a conservative think tank, finding that 97 percent of new Obamacare enrollment was a result of Medicaid expansion. This means that two thirds of the newly insured via Obamacare will remain insured, even in the unlikely scenario of repeal without replacement.
If the Medicaid expansion is kept in place, or even modestly expanded, the newly insured won't be tossed into the streets without insurance, as the naysayers predict. It seems that much of Obamacare was a mirage, claiming credit for something already in place – namely, getting those eligible for Medicaid to actually sign up and get enrolled in a program they had access to all along.
The mirage can work in reverse, too. If Obamacare goes away, it won't be the catastrophe big media and the left predict.
Brian C Joondeph, M.D., MPS, is a Denver-based physician and writer. Follow him on Facebook and Twitter.