[Congressional Record Volume 163, Number 17 (Wednesday, February 1, 2017)]
[Extensions of Remarks]
[Page E114]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  THE IMPACT OF THE REPEAL OF THE ACA

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                          HON. ROBIN L. KELLY

                              of illinois

                    in the house of representatives

                      Wednesday, February 1, 2017

  Ms. KELLY of Illinois. Mr. Speaker, I include in the Record this 
article concerning the repeal of ACA.

                       [From the Washington Post]

  Repealing the Affordable Care Act Will Kill More Than 43,000 People 
                                Annually

             (By David Himmelstein and Steffie Woolhandler)

       Now that President Trump is in the Oval Office, thousands 
     of American lives that were previously protected by 
     provisions of the Affordable Care Act are in danger. For more 
     than 30 years, we have studied how death rates are affected 
     by changes in health-care coverage, and we're convinced that 
     an ACA repeal could cause tens of thousands of deaths 
     annually.
       The story is in the data: The biggest and most definitive 
     study of what happens to death rates when Medicaid coverage 
     is expanded, published in the New England Journal of 
     Medicine, found that for every 455 people who gained coverage 
     across several states, one life was saved per year. Applying 
     that figure to even a conservative estimate of 20 million 
     losing coverage in the event of an ACA repeal yields an 
     estimate of 43,956 deaths annually.
       With Republicans' efforts to destroy the ACA now underway, 
     several commentators have expressed something akin to 
     cautious optimism about the effect of a potential repeal. The 
     Washington Post's Glenn Kessler awarded Sen. Bernie Sanders 
     (I-Vt.) four Pinocchios for claiming that 36,000 people a 
     year will die if the ACA is repealed; Brookings Institution 
     fellow Henry Aaron, meanwhile, predicted that Republicans 
     probably will salvage much of the ACA's gains, and 
     conservative writer Grover Norquist argued that the tax cuts 
     associated with repeal would be a massive boon for the middle 
     class.
       But such optimism is overblown.
       The first problem is that Republicans don't have a clear 
     replacement plan. Kessler, for instance, chides Sanders for 
     assuming that repeal would leave many millions uninsured, 
     because Kessler presumes that the Republicans would replace 
     the ACA with reforms that preserve coverage. But while repeal 
     seems highly likely (indeed, it's already underway using a 
     legislative vehicle that requires only 50 Senate votes), 
     replacement (which would require 60 votes) is much less 
     certain.
       Moreover, even if a Republican replacement plan comes 
     together, it's likely to take a big backward step from the 
     gains made by the ACA, covering fewer people with much 
     skimpier plans.
       Although Aaron has a rosy view of a likely Republican plan, 
     much of what they--notably House Speaker Paul D. Ryan (R-
     Wis.) and Rep. Tom Price (R-Ga.), who is Trump's nominee to 
     head the Department of Health and Human Services, which will 
     be in charge of dismantling the ACA--have advocated in place 
     of the ACA would hollow out the coverage of many who were 
     unaffected by the law, harming them and probably raising 
     their death rates. Abolishing minimum coverage standards for 
     insurance policies would leave insurers and employers free to 
     cut coverage for preventive and reproduction-related care. 
     Allowing interstate insurance sales probably would cause a 
     race to the bottom, with skimpy plans that emanate from 
     lightly regulated states becoming the norm. Block granting 
     Medicaid would leave poor patients at the mercy of state 
     officials, many of whom have shown little concern for the 
     health of the poor. A Medicare voucher program (with the 
     value of the voucher tied to overall inflation rather than 
     more rapid medical inflation) would worsen the coverage of 
     millions of seniors, a problem that would be exacerbated by 
     the proposed ban on full coverage under Medicare supplement 
     policies. In other words, even if Republicans replace the 
     ACA, the plans they've put on the table would have 
     devastating consequences.
       The frightening fact is that Sanders's estimate that about 
     36,000 people will die if the ACA is repealed is consistent 
     with well-respected studies. The Urban Institute's estimate, 
     for instance, predicts that 29.8 million (not just 20 
     million) will lose coverage if Republicans repeal the law 
     using the budget reconciliation process. And that's exactly 
     what they've already begun to do, with no replacement plan in 
     sight.
       No one knows with any certainty what the Republicans will 
     do, or how many will die as a result. But Sanders's 
     suggestion that 36,000 would die is certainly well within the 
     ballpark of scientific consensus on the likely impact of 
     repeal of the ACA, and the notion of certain replacement--and 
     the hope that a GOP replacement would be a serviceable 
     remedy--are each far from certain, and looking worse every 
     day.

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