U.S. Senate Republicans, looking for a health care bill that can win majority support in their chamber, have suggested a new, more modest plan: A “skinny repeal” of the Affordable Care Act.
What is it and how would it impact Colorado? Read on for answers.
Question: What is a “skinny repeal”?
Answer: In a way, it is the bare minimum that you can roll back the Affordable Care Act, the health care law that’s also called Obamacare, and still claim you have repealed it. The exact details of the proposal are unclear, since senators haven’t officially introduced anything.
But reporting by , , , and other outlets all agree on one major point: The proposal would repeal the individual and employer mandates in the ACA — those are the requirements that everybody have health insurance. It might also do away with a tax on medical devices.
Everything else that’s up for debate in an ACA repeal — the subsidies for people who buy their own insurance, funding for Medicaid, the Medicaid expansion — would apparently remain as it is under current law.
Q: After so much talk about repealing Obamacare, what’s the logic behind such a modest proposal?
:Officially, the plan is that a skinny repeal is only a placeholder while lawmakers from both the House and the Senate work on a bigger idea.
The House has already passed its own plan for repealing Obamacare, a proposal called . For the president to sign a bill into law, the House and the Senate must pass the same version of the bill, though, and the AHCA was a nonstarter in the Senate.
Republicans in the Senate first put forth more ambitious repeal proposals, . For the efforts to repeal the ACA to continue, the Senate has to pass something. That’s where the skinny repeal comes in.
As U.S. Sen. John Thune, a Republican from South Dakota, , the strategy is, “Whatever gets to 50.”
Once both chambers have passed their own version of a repeal, there are two options.
First, the House could just adopt the Senate’s version and send the bill onto the president. That prospect, though, worries senators who are otherwise inclined to support the skinny repeal. At , Sens. Lindsey Graham, R-S.C., John McCain, R-Ariz., and Ron Johnson, R-Wis., all announced that they would only vote for the skinny repeal if they received assurances that the House won’t adopt it.
What they want is the second option — a meeting called where the two chambers would hash out their differences and write, essentially, a new bill. This option makes it unlikely that the skinny repeal would make it to President Donald Trump’s desk intact.
Q: But, if it does, how would a skinny repeal impact insurance markets?
A: For such a scaled-back plan, a skinny repeal could have significant implications. The main impact comes from dropping the mandates and the ripples that follow.
With no requirement to buy insurance, the Congressional Budget Office that a repeal of the individual mandate would mean 15 to without health insurance nationwide by 2026 compared to current law. Some of those would be people who don’t want to have to buy insurance. But others would likely be people who want insurance but feel they can’t afford it, according to the CBO.
The ripples start, though, when you look at who those people are.
The CBO projects that those dropping out of the market would likely be younger and healthier, on average, leaving the remaining insurance pool relatively older and sicker. That trend would probably freak out insurers, who would respond to a more expensive pool by raising premiums for the remaining beneficiaries. (The CBO estimates that premiums in 2026 nationwide without a mandate than they would be if the mandate remains in place.) In , this creates a feedback loop that crashes the individual health insurance market.
The federal government would spend more providing subsidies to people who buy their health insurance on their own — though it would also save money by not providing subsidies to those who bailed. In total, the CBO has that eliminating the individual and employer mandates would save the federal government $381 billion in the first decade.
Meanwhile, repealing the medical device tax would reduce federal revenue by $19.6 billion in that time.
Q: How would a skinny repeal impact Colorado?
A: Because there isn’t any official language for the skinny repeal yet, there aren’t many state-by-state breakdowns of its impacts. But, Democrats in the Senate — who, needless to say, are opposed to the plan — have cobbled together their own estimates based on prior reports and studies.
The Democrats’ concludes that 269,300 more people would be uninsured in Colorado in 2026 than under current law and annual premiums would be, on average, $751 higher.
Colorado hospitals would have to absorb $242 million more in uncompensated care, according to the Democrats’ analysis. If that happens, it could or cause hospitals to raise prices for everybody else.
A second concern is that, if insurers are spooked by federal policy changes, from the state as early as this year. That would leave people shopping on their own for health insurance with fewer — or no — choices.