Republican lawmakers have said they plan to repeal the Affordable Care Act when President-elect Donald Trump is in office, with a one or two-year transition period before it takes effect to give customers notice.
Repealing Obamacare without replacing it could lead insurers to exit the program to avoid losses, according to Politico.
"The discussion right now about repeal and replacement is making the market very, very nervous. I would not be surprised to see the potential for a stampede to exit the market," said Washington Insurance Commissioner Mike Kriedler, notes Politico.
Insurers would have a tight deadline of a few months to decide to stay in the law's marketplaces in 2018. Uncertainty over whether it will be repealed with no replacement could lead to insurance being cut off for millions, Politico reports.
"A repeal that kicks the can on replace would put the market in serious jeopardy and the American people will hold them accountable for the results," Center for American Progress health policy chief Topher Spiro said on a conference call to Obamacare supporters.
Obamacare coverage is in high demand. During the first two weeks of the current enrollment season, more than 1 million people signed up. On the day after the presidential election, 100,000 joined the program.
Politico notes President Barack Obama's administration estimated that 13.8 million people would be participants in the current season, which ends around two weeks after Trump takes office.
Many of those people would be affected by the lack of Obamacare, Politico reports, according to Molina Healthcare CEO Mario Molina.
"Health care and health insurance is an area where the devil really is in the details. It's a big, big issue and if you get it wrong it can harm a lot of people," Molina said.
Iowa Insurance Commissioner Nick Gerhart, a Republican appointee agreed, saying repealing with no replacement would have "devastating consequences in the disruption to people's care."
Alliance of Community Health Plans CEO Ceci Connolly doubts that allowing one year to transition out of the program would be enough, and stressed that the incoming administration needs to clear up their plans.
"It's enormously important for the incoming administration and Congress to be very clear about their intentions, because the worst thing for business is uncertainty," Connolly said, reports Politico.
Republicans have said they would use reconciliation, a process that requires 51 Senate votes, which would keep Democrats from blocking the plan. However, that method only blocks the parts of Obamacare that are linked to federal funding.
According to Politico, it's likely that lawmakers could not toss the part of the plan that does not discriminate against preexisting conditions — a part of the plan that Trump has said he likes.
Insurers would have no guarantee that Congress would set up a replacement for the program, Politico reported.
Insurers could exit the program even sooner if Republicans remove funds to provide cost-sharing with low-income customers. A clause in the Obamacare contract allows insurers to cut off coverage if the government eliminates those subsidies, according to Politico.
Insurance consultant John Gorman warned about the impending consequences of a repeal. "This is like trying to develop a plan for the zombie apocalypse. It's never been done before," Gorman said.
According to the Los Angeles Times, Republican's plans to repeal Obamacare could be disruptive. "There is significant risk of chaos. If they don't get this right, a lot of people will suffer," said Iran Morrison, a healthcare consultant.
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