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If Obamacare Is Repealed …

Tuesday, April 24th, 2012

Right now, the odds that the Affordable Care Act (ACA) will survive long enough to be fully implemented seem pretty long. Even if the Supreme Court doesn’t strike it down as unconstitutional this summer, a Republican victory in November would probably lead to its repeal.

The ACA, also called “Obamacare,” is not very popular according to polls. However, polls also show that many Americans don’t understand the complex law. Voters who support anti-Obamacare candidates may not like the results if their candidates win.

Seniors with serious health issues such as mesothelioma cancer are especially vulnerable to a loss of medical care.  One of the trustees of the Medicare warns that if “Obamacare” is struck down or repealed, the effect on Medicare could be devastating.

The trustee, economist and former Urban Institute President Robert Reischauer, spoke at the American Enterprise Institute this week. He said that partly as a result of “Obamacare,” the growth of health care cost has slowed dramatically, and the entire health care system seems to be moving in a more sustainable direction. But if the ACA is struck down or repealed, Reischauer said, those improvements would be reversed.

More critically, Medicare payments would be thrown into chaos. The ACA rewrote the laws that determine how health care providers are reimbursed. If the ACA is nullified, two years of policy and processes will be canceled. Sara Rosenbaum, a professor of health law and policy at George Washington University, said the entire health care system could come to a halt.

“You have agencies sitting on two years of policies that are up in smoke,” she said. “Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly, closing the doughnut hole might not happen. We don’t know.”

And because these same hospitals and nursing homes also serve non-Medicare patients, all patients could be affected.

The “doughtnut hole” is a gap in Medicare prescription drug coverage that causes some seniors to pay thousands of dollars out of pocket for their medicines. The ACA has partly closed the hole, and if it isn’t struck down it will close the entire hole in a few years. If the ACA is struck down, the “hole” will open up again.

This is not necessarily an argument for preserving the ACA as it is. However, if any part of it is repealed, there needs to be a law already written to replace it. Otherwise, the entire U.S. medical system could find itself in the Twilight Zone.

Tom Billet, a senior benefits consultant with Towers Watson, warns that the nation’s employers may not be prepared for the consequences if Obamacare suddenly disappears. “Employers had been the major force driving health care change in this country up until the passage of health reform,” he said. “If Obamacare disappears … we go back to square one. We still have a major problem in this country with very expensive health care.”