Creating Obamacare wasn’t a picnic. Repeal can’t be, either.

Repealing Obamacare would hurt patients, providers and the economy. Rural hospitals would be at risk and emergency departments could close, making it less likely rural people with heart attacks and strokes survive.

Simply wiping out the Affordable Care Act would be reckless governance. Voting now for repeal with a replacement to be crafted later is also terrible policy with awful consequences.

Former Maine Sen. Olympia Snowe participates in a panel of Maine's current and former U.S. senators in October 2016. Snowe was involved in negotiating the Affordable Care Act. Micky Bedell | BDN

Former Maine Sen. Olympia Snowe participates in a panel of Maine’s current and former U.S. senators in October 2016. Snowe was involved in negotiating the Affordable Care Act. Micky Bedell | BDN

Obamacare wasn’t created rapidly. Seven and a half years ago former Maine Sen. Olympia Snowe sat at a table working out details for what was to become the Affordable Care Act. To keep negotiators going, Senate Finance Committee Chairman Sen. Max Baucus, D-Montana, and his staff put out munchies such as pretzels and beef jerky.

While Snowe noted, “The food leaves something to be desired,” she praised the environment created by the chairman, saying, “The talks are free-flowing. Max is very inclusive.”

There may have been snacks that summer of 2009, but expanding health care has never been a picnic.

Despite the months of hearings by five congressional committees and the bipartisan negotiations, no Republican was to vote for the Affordable Care Act. The rise of the tea party and the GOP leadership’s stated interest in denying President Obama support for his legislative agenda saw to that.

The Affordable Care Act, which brought the percentage of Americans without health insurance to its lowest level in American history, built on the work of presidents going back to Franklin Roosevelt. Now Speaker of the House Paul Ryan wants to go beyond repealing it to privatizing Medicare and turning Medicaid into block grants. President-elect Trump has long promised to repeal the ACA right away.

Just on fiscal grounds a repeal would be damaging. The Committee for a Responsible Federal Budget reports that, “A full repeal of the ACA would cost $350 billion through 2027 under conventional scoring and $150 billion under dynamic scoring.” Attempts to replace the ACA at some point would run into money trouble since “Repealing the entire ACA would leave no funds available for ‘replace’ legislation, and in fact would require further deficit reduction to avoid adding to the debt.”

Repeal would also hit our economy hard. The Commonwealth Fund projects a loss of 2.6 million jobs nationally, largely in the private sector. There would be a “$2.6 trillion reduction in business output from 2019 to 2023. States and health care providers will be particularly hard hit by the funding cuts.” As two conservative health economists recently concluded, repealing and replacing later would destabilize insurance markets.

Maine’s health care sector has been a bright spot for the state’s economy, but a repeal would damage it, threatening rural hospitals the most as the costs of providing uncompensated care spike.

Most important is the impact on people who gained coverage. According to the Urban Institute, a partial repeal that uses the budget reconciliation process, as is often discussed, would lead 29.8 million people, 80 percent of whom work, to lose insurance, including 4.4 million children. Some 95,000 Mainers would lose coverage. Between 2019 and 2028, Maine would lose $4.7 billion in federal funds.

Those big numbers obscure the human costs to losing coverage, including to two people I know who have cancer.

Any replacement should go through the same process as the ACA, with hearings, negotiations, budgetary estimates and time for analysis and critiques. That will allow all to see who and how many would be covered and at what cost.

Because it took time to develop, the ACA has mechanisms that work together. Cheaper prescription drugs for Medicaid recipients and free preventive care for all lower health care costs. The unpopular individual mandate is needed in order to preserve popular elements such as requiring insurance companies to sell to people with preexisting conditions and having no lifetime caps on coverage. Modifying elements willy-nilly would increase the ranks of the uninsured while rapidly increasing prices.

Sen. Susan Collins opposes the terrible idea of repealing Obamacare without any replacement because it would cause “a gap in coverage” but would accept another inadequate scheme, “a detailed framework that tells the American people what direction we’re headed.” It’s positive that Collins voted against making it easier to change Medicare and Medicaid and opposes immediately dropping current funding mechanisms for Obamacare that would be needed to support any replacement.

What is clear is that a flat repeal or “repeal and run” approach would create enormous damage.

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Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.