/ The Washington Post /
For weeks now, Republicans have employed a range of tortured talking pointsdesigned to push one idea: The GOP repeal-and-delay plan will not leave anyone without health coverage, and is merely designed as a transition that will ultimately move us seamlessly to the new, improved health care system Republicans envision, with the details to be worked out later.
But here’s the problem. If Republicans repeal the Affordable Care Act and delay the date that repeal takes effect, to give themselves time to develop their alternative, it could still create massive disruptions in the interim, even if you presume that the GOP replacement may materialize.
For instance, many insurers might exit the market, even if repeal hasn’t yet taken hold, simply because there is no guarantee that this GOP replacement will ever come to pass.
A new analysis suggests that some of the impact of these disruptions might end up concentrated in Republican areas.
The Congressional Budget Office recently examined a version of the GOP repeal-and-delay bill — one passed by Republicans in 2015 and vetoed by President Obama — and concluded that, because of insurers exiting the market, some 10 percent of Americans might be left living in an area that had no insurers participating in the individual market at all.
It turns out that 10 percent of the population might end up being concentrated in Republican areas.
Jeanne Lambrew, who was a key Obama administration official involved in implementation of the ACA, conducted a new analysis designed to try to determine where that 10 percent reside. Using data furnished by the Kaiser Family Foundation, Lambrew singled out counties that fill two criteria: First, that they have low populations; and second, that they currently only have one insurer serving customers on the individual market.
Those are the counties that, Lambrew concluded, would be most likely to be left without any insurer at all under any GOP repeal-and-delay plan. Those counties are depicted in red on the map below (run your cursor over it to determine the individual counties involved):
As you can see, many of the counties in red are in states like Alaska, Utah, Wyoming, Oklahoma, Texas, Missouri, Mississippi, Alabama, Tennessee, Georgia, South Carolina, Kentucky, and West Virginia. (Some counties are in swing or blue states like North Carolina, Nevada, Ohio, Pennsylvania, Wisconsin, and Illinois.) The study was conducted by Lambrew for the Century Foundation.
Larry Levitt, a senior vice president at the Kaiser Family Foundation, tells me that this analysis broadly tracks with what Kaiser believes is a reasonable projection of the outcome under repeal-and-delay. He emails that if the GOP repeals the ACA on a delay, it could very well leave large swaths of the country with no insurers in the individual market, and that this could strand a lot of people in those areas with no insurance — even those who continue to get subsidies in the interim before repeal takes hold:
Overall the individual insurance market under the ACA seems to be stabilizing, and it shows no signs of collapsing if it’s left alone. There are still parts of the country where markets are fragile, though. The risk to the insurance market now is that Congress or the Administration could do something to destabilize it.
That would very likely leave some communities with literally no companies willing to sell individual insurance. People eligible for premium subsidies under the ACA couldn’t use them because there would be no insurance to buy. Even higher income people not eligible for subsidies, like the self-employed, might not be able to buy insurance.
This could be politically relevant, because many of these states with these concentrations are represented by Republican Senators (and lots of GOP Representatives). Such lawmakers — if they are worried about how the disruptions of repeal-and-delay might impact their states and constituents — might be a bit more inclined against going along with repeal-and-delay without a meaningful replacement being developed first.
The creation of areas with zero insurers is by no means the only disruption that GOP repeal-and-delay might cause (others might include rising premiums, the CBO concluded). But it is one worth keeping in mind. It might undercut an argument often made by GOP lawmakers — that their alternative will bring more choice and competition — since repeal-and-delay would instead leave many of their own constituents with no choices at all.
It’s always possible, of course, that Republicans could go forward with repeal-and-delay-with-no-guaranteed-alternative in spite of such worries, because the base won’t have it any other way. But, with doubts already rising among GOP lawmakers who clearly see that they could suffer major political blowback from the chaos that this course of action is likely to unleash, here is another thing for them to worry about.