As they race to repeal large parts of the Affordable Care Act,
President-elect Donald Trump and congressional Republicans are leaving
behind nearly everyone but their base voters and a handful of
conservative activists.
Not a single major organization
representing patients, physicians, hospitals or others who work in the
nation's health care system backs the GOP's strategy.
New polls also show far more Americans would like to expand or keep the health care law, rather than repeal it.
Even
many conservative health policy experts caution that the emerging
Republican plan, which calls for a vote in January to roll back
insurance coverage followed by a lengthy period to develop a
replacement, could be disastrous.
Intensifying the political risks
for Republicans, a growing number of patient groups are warning that
millions of Americans are in danger of losing vital health protections
and that Republicans need to agree on a replacement plan before they
uproot the current system.
"When people get cancer, they have to
know that they are going to have insurance," said Chris Hansen,
president of the American Cancer Society's advocacy arm. "There have
been and are problems with the ACA, but we have to make sure that what
is done and the way it is done is not going to leave people who have
cancer or who may get cancer ... in the lurch."
The American
Cancer Society Cancer Action Network last week sent a letter to
congressional leaders urging them not to repeal large parts of the
health care law without first developing replacement legislation that
guarantees patients the same protections.
GOP leaders, who have
repeatedly promised their core voters that they would repeal the law,
oppose any delay in a vote, despite the risk that Republicans may be
held responsible for any ensuing turmoil.
They are pushing to pass
a bill early next year that would repeal many key provisions of the
law. That would include the money that has allowed states to expand
their Medicaid safety nets and the billions of dollars in federal funds
that have provided subsidies to low- and middle-income Americans to help
with the cost of insurance premiums. More than 20 million Americans who
previously lacked insurance have gained coverage under the law.
"We
have to bring relief to Obamacare as quickly as possible so that it
stops doing damage, not just to the health care system but to the
families of America who need affordable health insurance," House Speaker
Paul Ryan, R-Wis., told reporters at the Capitol last week.
To
minimize disruptions, senior Republicans want to delay when the cuts
would take effect. The idea is to buy time to allow the party to develop
an alternative — something that GOP lawmakers have been unable to agree
on in the six years since the law passed.
That approach has won
praise from several conservative think tanks, including the Heritage
Foundation, which said the so-called repeal-and-delay strategy could
deliver "a seamless and successful repeal of Obamacare."
Most independent experts are more skeptical.
Last
week, the American Academy of Actuaries warned in a letter to House
lawmakers that many insurers are likely to pull back from state
marketplaces even if the effective date of a repeal is delayed.
"Significant market disruption could result, leading to millions of Americans losing their health insurance," the group said.
Similar
warnings have come from the Republican insurance commissioner of Iowa
and some leading conservative critics of the current law, such as James
Capretta of the American Enterprise Institute and John Goodman of the
Texas-based Goodman Institute.
Goodman, who has been working with a
group of GOP lawmakers on an alternative to the Affordable Care Act,
cautioned that the current repeal plans would eliminate the taxes that
provide hundreds of billions of dollars to fund coverage.
Ryan has
said the GOP's eventual plan would preserve coverage for the millions
of people who depend on the current law. Without those taxes, however,
Republicans would not have a clear way to do that unless they find some
other source of revenue, something that conservative lawmakers
repeatedly have balked at.
"If all Obamacare goes away, including
its funding sources, where does the money come from to continue the
insurance for the 20 million newly insured under the Affordable Care
Act?" Goodman wrote in a recent Forbes column.
Neither Trump nor his congressional allies have indicated how they would answer that question.
That
is adding to anxiety among major patient and medical groups, who fear
that Republicans may never be able to enact an alternative, given their
inability to develop one despite years of promises to do so.
"Any
new reform proposal should not cause individuals currently covered to
become uninsured," cautioned Dr. Andrew W. Gurman, president of the
American Medical Association, the nation's largest physicians' group.
In
2009 and 2010, the AMA was among the key groups in the health care
debate, along with the American Hospital Association, the American
College of Physicians, AARP and other patient advocates, who supported
the law and its promise of extending health protections to millions of
Americans.
Many of these groups would like to see changes made to the law, which even supporters say needs revision.
None has backed the GOP "repeal and delay" strategy.
Even
major industry groups that have been most vocal with complaints about
the law and opposed it when it was enacted, including the main health
insurance trade association, America's Health Insurance Plans, are not
backing the repeal campaign.
The health insurance group has
suggested a number of steps to minimize potential disruptions should
Republicans move ahead with legislation to roll back the law.
The reticence is mirrored in public views of the GOP repeal campaign.
Although Republicans strongly support it, most Americans do not, according to recent polls.
Just
39 percent of respondents in a national survey conducted over the first
days of December by the Pew Research Center said that Congress should
repeal the law, compared with 55 percent who said Congress should expand
it or leave it as is.
Support for repeal predictably was weakest
among Democrats, but even among independents, just 35 percent said
Congress should roll back the law, and 61 percent said the law should be
expanded or left alone.
Those findings track with another
national survey conducted in mid-November by the nonprofit Kaiser Family
Foundation, which found that just a quarter of Americans want to repeal
the law.
That was down from a third who backed repeal in October.
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