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Repealing the ACA without a Replacement The Risks to Am. Health Care : Obama, J.D.

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I Was There! Official L Receiver 2/12/2016
Apr 16, 2007
Health care policy often shifts when the country’s leadership changes. That was true when I took office, and it will likely be true with President-elect Donald Trump. I am proud that my administration’s work, through the Affordable Care Act (ACA) and other policies, helped millions more Americans know the security of health care in a system that is more effective and efficient. At the same time, there is more work to do to ensure that all Americans have access to high-quality, affordable health care. What the past 8 years have taught us is that health care reform requires an evidence-based, careful approach, driven by what is best for the American people. That is why Republicans’ plan to repeal the ACA with no plan to replace and improve it is so reckless. Rather than jeopardize financial security and access to care for tens of millions of Americans, policymakers should develop a plan to build on what works before they unravel what is in place.

Thanks to the ACA, a larger share of Americans have health insurance than ever before.1 Increased coverage is translating into improved access to medical care — as well as greater financial security and better health. Meanwhile, the vast majority of Americans still get their health care through sources that predate the law, such as a job or Medicare, and are benefiting from improved consumer protections, such as free preventive services.
We have also made progress in how we pay for health care, including rewarding providers who deliver high-quality care rather than just a high quantity of care. These and other reforms in the ACA have helped slow health care cost growth to a fraction of historical rates while improving quality for patients. This includes better-quality and lower-cost care for tens of millions of seniors, individuals with disabilities, and low-income families covered by Medicare, Medicaid, and the Children’s Health Insurance Program. And these benefits will grow in the years to come.

That being said, I am the first to say we can make improvements. Informed by the lessons we’ve learned during my presidency, I have put forward ideas in my budgets and a July 2016 article2 to address ongoing challenges — such as a lack of choice in some health insurance markets, premiums that remain unaffordable for some families, and high prescription-drug costs. For example, allowing Medicare to negotiate drug prices could both reduce seniors’ spending and give private payers greater leverage. And I have always welcomed others’ ideas that meet the test of making the health system better. But persistent partisan resistance to the ACA has made small as well as significant improvements extremely difficult.

Now, Republican congressional leaders say they will repeal the ACA early this year, with a promise to replace it in subsequent legislation — which, if patterned after House Speaker Paul Ryan’s ideas, would be partly paid for by capping Medicare and Medicaid spending. They have yet to introduce that “replacement bill,” hold a hearing on it, or produce a cost analysis — let alone engage in the more than a year of public debate that preceded passage of the ACA. Instead, they say that such a debate will occur after the ACA is repealed. They claim that a 2- or 3-year delay will be sufficient to develop, pass, and implement a replacement bill.

This approach of “repeal first and replace later” is, simply put, irresponsible — and could slowly bleed the health care system that all of us depend on. (And, though not my focus here, executive actions could have similar consequential negative effects on our health system.) If a repeal with a delay is enacted, the health care system will be standing on the edge of a cliff, resulting in uncertainty and, in some cases, harm beginning immediately. Insurance companies may not want to participate in the Health Insurance Marketplace in 2018 or may significantly increase prices to prepare for changes in the next year or two, partly to try to avoid the blame for any change that is unpopular. Physician practices may stop investing in new approaches to care coordination if Medicare’s Innovation Center is eliminated. Hospitals may have to cut back services and jobs in the short run in anticipation of the surge in uncompensated care that will result from rolling back the Medicaid expansion. Employers may have to reduce raises or delay hiring to plan for faster growth in health care costs without the current law’s cost-saving incentives. And people with preexisting conditions may fear losing lifesaving health care that may no longer be affordable or accessible.

Furthermore, there is no guarantee of getting a second vote to avoid such a cliff, especially on something as difficult as comprehensive health care reform. Put aside the scope of health care reform — the federal health care budget is 50% bigger than that of the Department of Defense.3 Put aside how it personally touches every single American — practically every week, I get letters from people passionately sharing how the ACA is working for them and about how we can make it better. “Repeal and replace” is a deceptively catchy phrase — the truth is that health care reform is complex, with many interlocking pieces, so that undoing some of it may undo all of it.

Take, for example, preexisting conditions. For the first time, because of the ACA, people with preexisting conditions cannot be denied coverage, denied benefits, or charged exorbitant rates. I take my successor at his word: he wants to maintain protections for the 133 million Americans with preexisting conditions. Yet Republicans in Congress want to repeal the individual-responsibility portion of the law. I was initially against this Republican idea, but we learned from Massachusetts that individual responsibility, alongside financial assistance, is the only proven way to provide affordable, private, individual insurance to every American. Maintaining protections for people with preexisting conditions without requiring individual responsibility would cost millions of Americans their coverage and cause dramatic premium increases for millions more.4 This is just one of the many complex trade-offs in health care reform.

Given that Republicans have yet to craft a replacement plan, and that unforeseen events might overtake their planned agenda, there might never be a second vote on a plan to replace the ACA if it is repealed. And if a second vote does not happen, tens of millions of Americans will be harmed. A recent Urban Institute analysis estimated that a likely repeal bill would not only reverse recent gains in insurance coverage, but leave us with more uninsured and uncompensated care than when we started.5

Put simply, all our gains are at stake if Congress takes up repealing the health law without an alternative that covers more Americans, improves quality, and makes health care more affordable. That move takes away the opportunity to build on what works and fix what does not. It adds uncertainty to lives of patients, the work of their doctors, and the hospitals and health systems that care for them. And it jeopardizes the improvements in health care that millions of Americans now enjoy.

Congress can take a responsible, bipartisan approach to improving the health care system. This was how we overhauled Medicare’s flawed physician payment system less than 2 years ago. I will applaud legislation that improves Americans’ care, but Republicans should identify improvements and explain their plan from the start — they owe the American people nothing less.

Health care reform isn’t about a nameless, faceless “system.” It’s about the millions of lives at stake — from the cancer survivor who can now take a new job without fear of losing his insurance, to the young person who can stay on her parents’ insurance after college, to the countless Americans who now live healthier lives thanks to the law’s protections. Policymakers should therefore abide by the physician’s oath: “first, do no harm.”

Mr. Obama is the former President of the United States.


Sep 17, 2009
Mr. Obama is not the proper title, a former President is still referred to as Mr. President.


Jul 12, 2009
If there is one thing that unites Republicans is to do the opposite of what ex-President Obama says or wants. Expect them to entrench themselves on the idea of repeal and delay.


Sep 28, 2015
And we were dreaming about Clinton appointing Obama to the supreme court. How did we get to this... It is a shame seeing him have to defend one of his landmark accomplishment from a wannabe tyrant and a corrupt political party filled with sadists.


Nov 21, 2014
Sounds good, but I don't listen to random unemployed dudes on the internet.

Master Yoshi

May 4, 2014
Hey look, a well informed fucking Presidential statement that I can comprehend and stand behind.

God damn we fucked up.

When the ACA is repealed, I expect protesting to become far less civilized.


Jan 21, 2010
The Internet
"Obama is the former President of the United States"

still hurts


Jun 17, 2014
Sure lets see about that

*looks up Mr. Obama's credentials*

Hmm this seems legit guys

Why does an average Obama get his own thread and why should I care about anything he has to say about video games?

I kid, of course.

Honestly however not much to be said against that article, repealing the ACA without a replacement isn't the way to go. His closing words on the article are dead on the spot, and I hope the Republicans can acknowledge that it is incredibly short-sighted to just repeal it without any proper replacement plan made first. I mean I'd love to shoot themselves in the foot just for the shitstorm it'd cause, but not at the expense of human lives like it is the case here.


Sep 12, 2005
Smooth transition of power hurr durr. Shut the fuck up, Obama.

I can't tell if this is serious or not, but just in case: a smooth transition of power does not mean agreeing with all the policies of the new administration.

What is objectionable about this letter? How is this letter proposing anything other than the utilisation of basic common sense?


May 11, 2013
I'm pretty sure academic journals generally only refer to you by relevant titles in any case. Being the Marquis of Queensbury has no bearing on your academic value, being a Chief Justice of the Supreme Court might in the context of a Law Journal but not a Medical one.


Mar 14, 2013
can a "J.D." or "former" "president" tell proper crowd sizes? why should i listen to him on healthcare


Oct 1, 2015
I can't tell if this is serious or not, but just in case: a smooth transition of power does not mean agreeing with all the policies of the new administration.

What is objectionable about this letter? How is this letter proposing anything other than the utilisation of basic common sense?

Racist fascists are running the country. His message: "please be moderate when repealing Obamacare".


Nov 17, 2014
Health care reform isn't about a nameless, faceless ”system." It's about the millions of lives at stake — from the cancer survivor who can now take a new job without fear of losing his insurance, to the young person who can stay on her parents' insurance after college, to the countless Americans who now live healthier lives thanks to the law's protections. Policymakers should therefore abide by the physician's oath: ”first, do no harm."

I can totally hear him saying this. If only his peers would think about the lives at stake for one single minute before setting everything on fire. Those men will be on their deathbeds still thinking about money.

The word "former" still hurts though. :(
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