This week our new Congress will begin the process of repealing the Affordable Care Act (ACA). At this time, it appears that there is no plan for its replacement, a delay of which could have a devastating and destabilizing effect on our health care system.

The foundation of the ACA is increased access to both Medicaid and private health insurance, enabling millions of people without employer-sponsored health insurance to be covered – many for the first time. And for many of the newly insured, visiting a primary care provider was their first step into our health care system.

A repeal of the ACA without a plan for replacement will likely cause chaos in the insurance market, leading to uncertainty for the 30 million individuals who have been covered through the health insurance exchanges and the expansion of Medicaid and may not be able to keep their insurance.

We know that the uninsured – and particularly the lowest income – are less likely to seek medical or dental care, and when they do it is often for more costly urgent or emergent care. National data showed that as health insurance coverage increased, more people reported having a regular place to go for medical care and had seen or talked with a health professional during the last 12 months.

Primary care providers, the backbone of the safety net, will be hard hit, as the ACA increased both primary care spending and jobs. The Urban Institute projects repeal of the ACA will lead to a reduction of $20 billion for physician practices (primary and specialty care) in 2018 alone, with an expected $11.9 billion increase in uncompensated care. This goes up considerably in the out years.

Our first step as the primary care sector is to advocate for no repeal until a replacement plan is provided and vetted. We believe that the following key principles, among others, must form the bedrock of any plan:

• First, access to coverage must be universal and affordable.
• Second, primary care must be funded adequately and fully.
• Third, preventive services must be covered without any out-of-pocket costs.
• Fourth, all services should be covered, including women’s reproductive health care and behavioral health.
• Finally, funding for federal health insurance programs must be, at a minimum, maintained at current levels without cost shifting to the states or consumers.

Today, advocates from across the country will be calling Congress and let lawmakers know the impact that ACA repeal will have on you, your community, and your practice. We encourage you to join.

Without the retention of access, affordability, and coverage, a new plan cannot truly be called a replacement.

For more information, keep in touch with PCDC.

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