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Five dire predictions if Obamacare is repealed but not replaced

If Republicans in Congress successfully repeal parts of Obamacare without replacing them, 18 million people could lose their health insurance within a year. Within a decade, that number could rise to 32 million.

These consequences and more were laid out Tuesday in a new report by the nonpartisan Congressional Budget Office, days after both houses of Congress began the process of repealing Obamacare.


While Donald Trump promised last week that an Obamacare replacement will be passed “on the same day or the same week… could be the same hour” as any repeal, there is still confusion over what that replacement will be and skepticism among Republicans in Congress about whether they can accommodate such a tight timeline.

Repealing large swaths of the healthcare law requires only 51 votes in the Senate, whereas most replacement options being floated would require 60 votes (Republicans currently have 52). Drafting legislation is also a slower process than excising it; congressional Republicans have introduced several replacement alternatives but have not unified behind one. Trump cast further uncertainty this past weekend when he told the Washington Post that he was working on his own replacement plan with “insurance for everybody.”

And Republicans are now trying to repeal a law that’s as popular as it has ever been, according to a new NBC/WSJ poll that found support at 45 percent.

If the incoming Trump administration goes through with repealing the enormous law but cannot find a way to replace it, the CBO warned, the reactions of individuals, employers, states, insurers, doctors, and hospitals would be “hard to predict.” Still, these are the consequences the office foresees.

1. Insurance premiums will increase in the individual marketplace by 20 percent to 25 percent in the first year of the repeal, by 50 percent in the year after the Medicaid expansion ends, and by 100 percent by 2026. If Republicans repeal subsidies to help purchase insurance and remove tax penalties for not purchasing it, the CBO predicts that healthier and younger people will stop buying insurance, which will help drive a cycle of premium increases.

2. If sicker, less healthy people are the ones enrolling in the individual marketplace, insurers will abandon those markets even faster than they are now. In the first year of the repeal, the CBO predicts that about half of the people in the United States will live in an area with zero insurers participating in the individual marketplace. By 2026, the CBO predicts, approximately three-quarters of Americans will be living in such an area.

3. By 2026, there will be 59 million uninsured people in the U.S. under the age of 65. Currently, it’s 28 million.

4. By 2026, 32 million more people will be uninsured as a result of eliminating insurance subsidies and the Medicaid expansion.

5. By 2026, 11 million additional people will receive insurance through their employer instead of buying insurance on the individual market. In other words, in an era in which a dynamic gig economy is driven by people who are self-employed, an Obamacare repeal would discourage people from doing anything but staying tethered to full-time jobs.