An Open Letter to President-Elect Trump and the Members of the 115th Congress
RE: Repealing “Obamacare”
Beginning January 20, 2017 with the inauguration of President Trump, a vote to repeal Obamacare moves from political posturing to potential reality as the assured veto of prior bills by President Obama is no longer available. I urge members of the 115th Congress and President-Elect Trump to consider the real and varied consequences of any changes to the current programs.
Public reports indicate Congressional leaders are considering a sweeping repeal of Obamacare with implementation delayed until a replacement plan is developed. The uncertainty caused by such an approach will result in unintended negative consequences for the individual healthcare market.
Certain aspects of the current law function only because private insurers expect robust risk pools. The Health Practice Council of the American Academy of Actuaries recently sent a letter to House Speaker Ryan and Minority Leader Pelosi, expressing their concerns regarding a deterioration in individual health insurance markets if certain provisions of the Affordable Care Act are repealed without immediate replacement. You may find a copy of the letter at http://actuary.org/files/publications/HPC_letter_ACA_CSR_120716.pdf
I urge you to thoroughly understand the risks outlined in the letter before voting on any repeal measures. Unintended consequences can include significant premium increases by insurance carriers to offset increased uncertainty and reflect adverse selection in which younger and healthier individuals drop coverage. The adverse selection will quickly lead to spiraling premiums and contraction of markets as only high-risk individuals remain in plans and more insurance companies drop coverage. The number of uninsured would rise from current levels, leading to less preventative care and higher use of emergency services with their attendant costs.
I also caution you not to retain certain popular provisions of Obamacare without understanding the incentives necessary to make them work. For example, retaining pre-existing conditions protection without exorbitant costs requires either a very large enrollment base over which to the spread costs of that benefit or direct subsidies. Keeping the provision without providing appropriate incentives to provide one or both mechanisms will rapidly lead to a collapse in the individual healthcare market.
If you do not have sufficient experience with the actuarial and underwriting principles that underpin the individual insurance marketplace, I urge you to work with the American Academy of Actuaries to understand how those principles relate to any proposed legislation before casting your vote.
James M. Jackson