WashU Expert What happens if ACA is eliminated | Brown School at Washington University in St. Louis
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WashU Expert: What happens if ACA is eliminated?

Public Health; Faculty

​The Trump administration said this week that the whole Affordable Care Act (ACA) should be struck down in the courts. Doing so would have profound implications on health care and the economy, said an expert on health economics at Washington University in St. Louis.

“Not only would it repeal the marketplace plans coverage, which get most of the attention but yet cover only about 11.4 million people, but it would repeal a whole host of insurance reforms that affect many more millions of people, including protections against pre-existing condition exclusions,” said Timothy McBride, the Bernard Becker Professor at the Brown School and co-director of the Center for Health Economics and Policy.

“It would also repeal expansions for dependents up to age 26, and coverage expansion for the aged, including expanding their Part D prescription drug coverage,” McBride said. “The list of enhancements and improvements (that the ACA brings) to people’s health-care coverage is extensive.”

McBride said some 17 million Americans would lose health coverage overnight if the ACA, often called “Obamacare,” is struck down.

Repeal would have a huge impact on the health-care industry itself, which has been moving since 2010 to adapt to the ACA.

“The changes in Obamacare include many that are not widely known to the public, and include changes in the way health care is paid for and delivered and how we increase our workforce for health care,” McBride said. “It has profoundly changed the health insurance industry.”

The direct impact of repeal on the economy is hard to measure, he said, but on balance the changes are thought to bring about a negative impact on the health sector and dollars would move out of it and into other areas.

“The Congressional Budget Office projected that the ACA would reduce the deficit over time, so repealing it outright or having it declared unconstitutional would mean that the federal deficit would increase by a relatively small amount, which would have a small impact on the economy overall,” McBride said. “But underneath that, the changes would be large, from sector to sector.  Most of the employment growth lately has been in health care.”

Republicans have not put forth a replacement plan. Efforts to “repeal and replace” it have failed since President Donald Trump took office and made it a target.

“Even in the debates in 2017, the proposals were to partially replace Obamacare, leaving much of it in place outside of the individual mandate, and that was because it was assumed that the entire law would never be repealed legislatively,” McBride said.

“That is much less likely to happen now, and a replacement bill is much less likely to pass because we have a partisan Congress, with the House controlled by the Democrats and the Senate controlled by the Republicans.”