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Repeal of the ACA: Confused!



The GOP has as a priority repeal of the Affordable Care Act. No surprise there.

With that said; they want to keep:

  1. All individuals covered/even expanded coverage.

  2. No denial of coverage with pre-existing conditions.

  3. Children may stay on their parents insurance until age 26.

  4. Elimination of Lifetime Limits and

  5. The GOP even wants to continue Exchanges and Subsidies in some form.


  1. What exactly so they want to “repeal”?

  2. How do they propose paying for all the things they wish to keep?

  3. Is there even a skeleton of a replacement plan?


Because I am honestly confused at this point.


Just today: (1/04/2017):

" (Mike) Pence said that the “first order or business” for the new administration would be to repeal and replace Obamacare. Pence and Ryan, however, emphasized that they did not want to “pull the rug out from under” Americans who were dependent on the program.

“We don’t want people to be caught with nothing,” Ryan said."

My questions still stand.


I’m no expert on this type of policy, but I live in a working-class town and I know a lot of people, mostly single people with no kids in their 20’s and 30’s, who were PISSED about getting taxed for not buying health insurance.

Getting rid of that tax would be a good start.


Yet those same people (or their relative); if involved in a serious Auto or Motorcycle Accident…or a Home or Work injury…or if afflicted with cancer of diabetes or any other chronic illness…would most likely have the expectation of receiving the best available care…no questions asked.

Many would also expect grandma and grandpa to receive the best end-or-Life care available if needed…again, no questions asked.

Lastly…them being “pissed” still does not address the fundamental questions that I have about the repeal of the ACA. (Which appears to be going full-steam ahead).


I thought Ryan floated a replacement plan at some point?


I don’t know about that. The people I know who wait tables or do other work without insurance benefits don’t seem to be delusional enough to expect that, but perhaps you hang around a different breed of working class people.

I still think those people should have the freedom to take the risk of being uninsured and live with the benefits as well as the consequences. That tax isn’t small potatoes to a waitress or a massage therapist or a hair stylist who has to manage their money closely.

If that tax goes away it is a win in my book.



I doubt the working-class people I live and work with are much different than yours.


So you believe most working class people are unable to comprehend the risks of being uninsured?


I don’t know if I’d say “most” and I don’t know if I would say that people are entirely “unable to comprehend” the risks, but very loosely, I do think this is a concern.

In theory, I agree that people should not be “forced” to buy health insurance. If you’re young and healthy and want to take the risks of being uninsured, that’s fine with me.

But then hospitals should not be “forced” to treat those individuals. EMTLA explicitly forbids the denial of care to patients based on lack of ability to pay. And, in emergency situations (auto accident, severe heart attack) it may be difficult or impossible to determine whether the patient has the ability to pay, or insurance that will pick up the tab.

And now we come back around to the first portion of this discussion. I do believe that (some) people who many choose not to purchase any health insurance would balk at the notion of being denied care due to an inability to pay. Whether that is actually “most” or whether they are entirely “unable to comprehend” the risk, I’m not certain.


So, if these uninsured individuals were involved in a serious MVA, they would not expect to be taken to the hospital for life-saving emergency care? They would be content with a system that literally left them bleeding on the side of the road because of their lack of insurance?

Edit: Just read where @ActivitiesGuy made essentially the same points above.


@ActivitiesGuy @EyeDentist I don’t know. I haven’t asked them. It hasn’t come up in conversation since the other year when a lot of people I knew were saying “Thanks Obama” when they were forced to pay the tax.

Generally speaking, I don’t like forcing anyone to do anything. That includes forcing others to provide services without receiving compensation. Life and death circumstances certainly have a funny way of muddying that belief up though, don’t they?

As long as people go around expecting something for nothing, someone’s going to be disappointed. Either the person getting nothing for nothing or the person giving something for nothing. There’s no easy or simple solution here.


Here’s an idea:

Replace the ACA with a tax-payer funded catastrophic insurance plan that covers a specific and limited number of situations. Emergency room visit, heart attack, stroke, etc…

Allow insurance providers to compete across state lines (or internationally for all I care).

All additional insurance is procured at the individual level to his or her specifications (just like auto insurance). If you don’t want insurance you pay out of pocket per visit.

Incentives employers to provide preventative insurance plans and/or programs for healthy lifestyles (tax deductions are the most obvious way). Healthy food choices, educational programs, standing desks, etc…

That’s a start anyway.


I agree.

I am, unfortunately, not as well-educated as I ought to be on specifics of the ACA, so I am poorly positioned to discuss specifics of “Obamacare” in detail. I do, however, understand the appeal of making sure everyone has some form of health insurance because of the cases described above. As Mufasa pointed out in his very first post, the Republicans now want to keep some of the core tenets of Obamacare, but the problem is that some of those things don’t work very well without the other things being in place.

It’s a little old, but I remember a piece on Jimmy Kimmel a couple years ago where people on the street roundly bashed “Obamacare” but praised the “Affordable Care Act” (and I think a more formalized survey backed this up by showing that people were more likely to say that they opposed “Obamacare” than they were to say that they opposed the “Affordable Care Act”). There surely exist at least some people that are happy to hear “Obamacare” is going to be repealed just because of the association with Obama.


Republicans are trying to have their cake and eat it too. They are trying to keep the things they believe are popular even though those things raise costs.

Repeal the whole damn thing. Keep nothing.


Yes, that is my impression as well.


Trump can effectively repeal the law with a stroke of the pen. The law itself gives the executive branch the discretion to exempt any person, company, or organization from the mandate and any other given provision of the law. (It was basically a payoff to unions or whomever wanted to give enough cash to get exempt.)

Trump can simply order that “In accordance with Section [123] of the ACA, all persons and companies in or without the United States of America are hereby exempted from all provisions of the ACA.”

Only good until he leaves, but it would be a huuuuuge start.


The Republicans are like the dog that unexpectedly caught the bus it was chasing. Now that they have it, they have no idea what to do next.


You BET they are.




Does this go back to my original confusion, JB?

Does he even want to? With the desire of the GOP to essentially keep the more “popular” points of the ACA; do they really even want to “repeal” the Law…or just provide photo-ops and a huge Dog-and-Pony show to prove that they are living up to campaign promises?

I’m leaning toward the latter.