The Congressional Budget Office recently released a report assessing the impacts of an ACA repeal on, among other things, the national insurance rate and the cost of healthcare premiums. In that report, the CBO assumed that Congress would enact legislation this year repealing the individual mandate and then, in 2019, the premium tax credits and Medicaid expansion provisions of the statute. Under this scheme, the CBO concluded that the number of uninsured Americans would increase by 18 million in 2018, 27 million in 2020, and 32 million in 2026. In other words, 59 million Americans, or 21 percent of the U.S. population, will be uninsured by 2026 even if the ACA is repealed in piecemeal fashion. The CBO also concluded that a staggered ACA repeal would increase non-group market insurance premiums by 20 to 25 percent in 2018 and 100 percent in 2026. Equally concerning, the bi-partisan Committee for a Responsible Federal Government recently warned that a full ACA repeal could cost up to $350 billion over the next 10 years.
As dire as these predictions appear, reports indicate that an ACA repeal would work an even more detrimental impact on rural American peoples and economies, including those in Appalachia. Pointing to rural America’s increased mortality rates as well as higher rates of chronic illness, obesity, drug overdose, alcoholism, mental illness, and suicide, Professor Greenwood-Erickson writes: “[t]he health of rural America is failing, and a repeal of the [ACA] without adequate replacement could prove disastrous.”
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