Repealing the Affordable Care Act won’t be a big deal. Here’s why.


Supporters of the health care status quo are outraged, predictably, over what they see as Donald Trump’s search-and-destroy mission on Obamacare. They cite all of the newly insured people under the Affordable Care Act — then turn to gloom-and-doom scenarios, insisting everyone will lose insurance, especially those who are low-income and on Medicaid.

Change is never easy, and it can sometimes be scary when facts aren’t known. So will millions of people find themselves without health insurance — or is this simply a scare tactic to throw a wrench into Trump’s repeal and replace plans?

Who better to ask than Jonathan Gruber, the architect of Obamacare?

Gruber authored a report recently on this very topic — and his own findings throw cold water on many of the doomsday prophecies about repealing the ACA.

Roughly two-thirds of new Medicaid enrollees in 2014, he found, were already eligible for Medicaid under pre-existing eligibility criteria. In other words: It wasn’t Obamacare that made them eligible for Medicaid. They were eligible all along to receive the benefits they now enjoy. But for reasons unknown, they never signed up.

Why is this important? It means that when Obamacare is repealed, most of those people already on Medicaid will continue to receive their benefits. And all those people we’re told will be tossed out into the street without insurance — that isn’t going to happen. Even more will stay on Medicaid if some states maintain the same eligibility criteria post-repeal as they had during Obamacare.

The federal government will also save money, which might, in turn, be used to support a modest Medicaid expansion. Here’s why: Obamacare had the federal government paying states much more of the cost of each new Medicaid enrollee than before the ACA — not by choice, but by statute.

If you consider that Medicaid expansion is the reason for the clear majority of the newly insured under Obamacare, there is even less harm with repeal. A whopping 97 percent of the newly insured are Medicaid enrollees, according to the Heritage Foundation.

Combine this fact with Gruber’s study, and it’s safe to assume that two-thirds of all new Obamacare enrollees will not lose coverage after Trump’s repeal and replace.

Imagine that: People already eligible for Medicaid signed up and used it during Obamacare. That’s like telling a U.S. citizen he is eligible to vote — and then getting him registered. Big deal.

This should come as no surprise to those who remember the Gruber comments that were caught on video a few years ago discussing the “stupidity” of Americans. He also spoke of the stealth tax buried within Obamacare, which he described as “a very clever … basic exploitation of the lack of economic understanding of the American voter.”

Just like with his taxes, the Medicaid expansion was, in reality, a sleight of hand — it claimed credit for something already in place.

While President-elect Donald Trump prepares to dismantle Obamacare, we must realize that Gruber and the Obama administration perpetuated a mirage — it is mostly hollow. When the ACA comes crashing down, it isn’t likely to make much noise.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor. This article originally appeared in the HealthZette.

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