Among the many paths the GOP is considering as it confronts its pledge to repeal the Affordable Care Act is one in which it gradually undoes many of the landmark health law’s provisions in the hopes an incremental repeal would not leave so many people in a lurch.

Republicans are suggesting whatever legislation they plan to push through Congress in the coming months might repeal the ACA but not go into effect for another two years.

The problem, as discussed by The Hill, is that the ACA is premised on the participation of private insurers. Many that are already struggling to turn a profit with the plans they sell through Healthcare.gov are only sticking around with the hope that the business will become profitable in the long-term.

If Republicans give the ACA an expiration date, insurers will likely pull out of the exchange immediately.

“Even with a delayed effective date, the reconciliation bill approach would cause massive disruption and chaos in the individual market for health insurance,” says a report by the Center for American Progress, a liberal think tank. “The complete unraveling of the market would occur by the end of 2017.”

What is unclear is whether there will be a “replacement” that is included in the repeal legislation, or whether Republicans hope to spend the next two years figuring that out as the ACA slowly winds down.

Developing a replacement will likely not be easy for Republicans, who face divisions within their Congressional caucus about what to provide those who are currently dependent on the ACA, either because of marketplace plans or the Medicaid expansion. And it’s far from clear what President-elect Donald Trump, who has signaled an interest in keeping in tact some of the ACA’s most popular provisions, will want to see happen.

Democrats are preparing to highlight the effect of any repeal plan on the 20 million ACA beneficiaries.

“The first thing we have to do for the American people is we have to be honest with them about what he’s going to replace it with,” Sen. Claire McCaskill, D-Missouri, tells Politico. “And let’s see how that would work for the millions of people who have certainty and security right now. You can’t repeal it until we know exactly what you’re going to replace it with and when that’s going to go into effect so obviously they have some work to do.”

While some Republicans have signaled sensitivity to the plight of those who might lose coverage, others are beginning to suggest that such people wouldn’t be in such a bad place after all.

“People have crappy insurance now,” responds Rep. John Shimkus, R-Illinois, in the Politico article. “They have high costs, they have high deductibles, it’s like they don’t have insurance. So this fear that they’re going to lose something that they don’t think they have anyway is crazy.”

Instant Insights /

Republicans explore 'repeal and delay' strategy for ACA

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