The effort to repeal and replace the Affordable Care Act (ACA) is like the game Jenga, in which players must carefully pull blocks of wood from within a tower and place them on top without the whole thing collapsing.
Republicans in Congress and the Trump Administration want to remove some unpopular elements of the ACA, such as the individual mandate, leave others in place, and avoid having the whole individual insurance market collapse. Physician groups are watching nervously from the sidelines and urging the Republicans to retain key elements of the ACA. They also are trying to gauge what the impact of a repeal would be on their patients and practices.
With no clear consensus plan in place yet, new replacement proposals were being floated almost daily in late January. One would allow states to choose whether to keep or jettison the health insurance exchanges. There is one thing John Meigs Jr., president of the American Academy of Family Physicians, is sure of: "If they repeal the ACA without anything to replace it, it is going to create real problems," he says.
"In primary care, we still see the patients who don't have insurance," Meigs explains. "We take the loss or do some kind of discounted fee schedule to try to accommodate them. But it is extremely difficult to get an uninsured patient in to see a specialist." Also the ACA has significantly increased the number of people accessing preventive services such as mammograms and colonoscopies that they had been putting off. "Now they could go back to putting those off again," he says. "It could have a snowball effect."
Meigs pointed to a 2016 study by the Urban Institute and Robert Wood Johnson Foundation, which found that providers would be on the hook for more uncompensated care if the ACA were repealed.
The report estimates that the providers' share of uncompensated care would increase 109.2 percent in 2021 if the ACA were repealed, from $21.3 billion to $44.5 billion.