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Dismantling the ACA without replacement plan would be disastrous

Michael Dowling explains why destroying the Affordable Care Act without a plan wouldn't work.

Despite flaws, Affordable Care Act insures 23 million and provides access to critical services like addiction treatment

Imagine arbitrarily deciding to knock down your house with no plan for rebuilding it and no idea how to pay for it. In effect, that’s what the Trump administration had attempted to do in pressing for a court-ordered demolition of the Affordable Care Act — a dangerous strategy that would have jeopardized coverage for approximately 23 million Americans.

Faced with opposition from his own party, President Donald Trump on Tuesday wisely shelved plans to replace the ACA — through either a lawsuit or congressional action — until after the 2020 election. While that’s a welcome reprieve, the president’s continued obsession with unraveling the nine-year-old health law, better known as Obamacare, raises major concerns about the administration’s approach to public policy.

While the ACA has underlying flaws, continued efforts to repeal the health law without a concrete plan for replacing it is a gambit that threatens lives.

Before abruptly backtracking on Tuesday, the White House had hoped to force a congressional showdown by abolishing Obamacare through the courts, forcing lawmakers to come up with an alternative before the next presidential election.

“I made it clear to him that we were not going to be doing that in the Senate,” Majority Leader Mitch McConnell told reporters about his conversation with the president.

The larger question, which thankfully we won’t have to answer for at least two more years, is: What happens if Obamacare is overturned without a replacement plan?

Of the 23 million covered by the ACA, about 9.2 million receive federal subsidies. On average, those subsidies cover about 85 percent of the monthly premiums paid by customers in the 39 states that rely on the federal exchanges. Without those subsidies, health insurance would be beyond the reach of most of those people. In addition, more than 12 million low-income adults qualified for Medicaid coverage because the ACA expanded eligibility. If Obamacare goes away, how many of those people would be left uninsured?

Perhaps the biggest impact would be on the estimated 133 million Americans who have pre-existing medical conditions. If the law is struck down, how many of them would be prevented from buying insurance or unable to afford it because of higher premiums?

Doomsday scenarios

There are numerous other doomsday scenarios that could play out, including an inability to provide access to addiction treatment during an opioid epidemic that is killing tens of millions of Americans; the loss of protections from coverage caps previously imposed by insurance companies and employers; higher out-of-pocket costs that would be borne by Medicare recipients for preventive care, prescription drugs and other medical expenses; and harm to the estimated 2 million young adults younger than 26 who are covered by their parents’ insurance plans, thanks to the ACA.

Sadly, there will be countless victims if we continue down this dangerous path. As any contractor can attest, it’s a lot easier to tear down a house than it is to build one.

Despite some flaws, the US health care system — with all of its complex and interdependent parts — has been dramatically successful in saving and prolonging lives. We observe it every day at Northwell Health.

Positive change requires understanding, knowledge and careful thought, not just political diatribes. Ignorance can be dangerous, whether it’s promoted by the far right or left.

Michael Dowling is president and chief executive officer of Northwell Health, New York State’s largest health care provider and employer.

This op-ed appeared in Newsday.

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