The New York Analysis of Policy and Government presents a two-part examination of what would happen if Obamacare isn’t replaced.

There has been a great deal of discussion about the impact of replacing Obamacare. Perhaps more attention should be paid to what would happen if Obamacare is NOT replaced.

A Washington Free Beacon report quotes Aetna CEO Mark Bertoline, noting that “Obamacare Will Continue to Deteriorate If Nothing Happens…” Aetna has announced that it will leave Obamacare exchanges in Iowa and Virgina. Bertoline also stressed that “a reinsurance pool would be a better solution for really sick individuals…When you talk to a lot of constituents who have $6,000 deductibles, live in the five eastern counties of Colorado where there isn’t a doctor, a $6,000 deductible is not helpful.”

Writing for the Journal of American Physicians and Surgeons, Dr. Lawrence R. Huntoon, M.D.states:

“ObamaCare is designed to cheat both patients and physicians. It destroys patient choice and often disrupts continuing long-term patient-physician relationships. By implementing extremely high deductibles, co-pays, and out-of-pocket maximums, ObamaCare creates the illusion of coverage at the cost of unacceptably high premiums…In order to survive, physicians who depend on third-party payment will need to take appropriate legal measures to limit financial losses caused by ObamaCare. Many will likely reassess their plan participation as financial losses and bureaucratic impediments to care increase. Third-party-free practice models will become more attractive to many physicians. And, unfortunately, physicians who opt for hospital-subsidized employment in an attempt to escape the adversities of ObamaCare will only exacerbate the loss of choice for patients and the rationing of care by the so-called Accountable Care Organizations. Patients will also come to recognize that they are paying a very high price for the illusion of coverage under ObamaCare. As patients increasingly realize that, for the most part, they will be spending their own money for medical care during any given year, they will begin to look for better value in their medical care. Third-party-free physicians, who are able to provide timely access to care, and more face-to-face time with patients at an affordable cost, will become more attractive to many patients. Likewise, as high deductibles, high co-pays, and unlimited out-of-pocket costs are a reality under ObamaCare, health savings accounts will become more attractive to more patients. If one is going to spend one’s own money, one might as well spend tax-free money as opposed to after-tax money. “

A major concern about Obamacare has been its detrimental impact on full-time employment, a problem that would continue if the law remains in effect. Writing for Forbes last September, Michael C. Cannon noted: “Four percent of large employers are reducing hiring because of the cost of providing health benefits to them… ObamaCare will depress wages for high-skilled workers by 1.3 percent and for low-income workers by 3 percent.”

The harsh economic impact of Obamacare doesn’t receive adequate attention. Casey B. Mulligan writes in Side Effects and Complications: The Economic Consequences of Health-Care Reform that the economy, and particularly employment, are detrimentally affected.

Edward Morrissey, writing for the Fiscal Times, concurs. He cites a Goldman Sachs study that demonstrates that employers have reduced full-time positions in favor of part-time ones that don’t require them to provide health insurance. That trend will continue if Obamacare is not repealed.

The continued existence of Obamacare-related taxes also would serve as an ongoing drag on the economy. Americans for Tax Reform’s John Kartch lists the $1 trillion in taxes that would be repealed if the legislation were overturned:

Obamacare Individual Mandate Tax

Obamacare Employer Mandate Tax

Obamacare’s Medicine Cabinet Tax
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Obamacare’s Flexible Spending Account tax

Obamacare’s Chronic Care Tax

Obamacare’s HSA withdrawal tax.

Obamacare’s 10% excise tax on small businesses with indoor tanning services.

Obamacare health insurance tax.

Obamacare 3.8% surtax on investment income.

Obamacare medical device tax.

Obamacare tax on prescription medicine.

Obamacare tax on retiree prescription drug coverage.

The Report concludes tomorrow.

In a 51-48 vote, The Senate yesterday took an important step to replace Obamacare. The measure was a nonbinding budget bill that establishes the path for a repeal of the failing Affordable Care Act within the next few months.

U.S. Senate Majority Leader Mitch McConnell (R-KY) stated “Too many have been personally hurt by this law. Too many feel they’re worse off than they were before Obamacare…Too many Americans say their Obamacare plans are too expensive to actually use. Too many say their Obamacare premiums have gone up and up though their options have diminished.”

While, as the 51-48 vote indicates, repeal is largely the work of the Republican majority, the reality is that Obamacare was collapsing under its own weight in what some pundits have termed a “death spiral.” Skyrocketing premiums, diminished choices, physicians opting to not take Obamacare-covered patients, a sharp decline in enrollments, and vanishing co-ops have been key indicators that its demise was inevitable. Public support for the 2010 Affordable Care Act legislation, which was passed without the public being informed of the details (former House speaker Nancy Pelosi (D-California) famously told the public that they would have to pass the bill to see what was in it) had dropped precipitously. Subsequent to its enactment, the laws’ architect, Jonathon Gruber attributed its passage to the “stupidity” of the American people.

Young people have been forced to buy policies which included costs for services they didn’t need. Seniors have been denied necessary treatments because of expense factors. Those with irregular incomes face constant changes in coverage. Physicians are drowning in inadequate reimbursement and bureaucracy. Obamacare in general charges excessive rates and imposes deductibles that make the concept of coverage more illusion than reality.

Many of the legislation’s own advocates had seen it as only an interim step towards the implementation of completely nationalized health care under a single payer plan. But that could not be sold to an American public that was well aware that the concept has failed wherever it has been tried. Indeed, many in the United Kingdom, whose National Health Service was, quietly, the admired model of Obamacare advocates, have sought methods to extricate themselves from their failing system.

Those advocates who have claimed that Obamacare has had some success are fudging facts. As the National Center for Policy Analysis, quoting a Heritage study noted in 2014: “while health insurance coverage — whether in the private market or in Medicaid — grew by 8.5 million individuals in 2014, the vast majority (71 percent) of that gain was due to increases in Medicaid. According to the authors, “[T]he inescapable conclusion is that, at least when it comes to covering the uninsured, Obamacare so far is mainly a simple expansion of Medicaid.”

The need to address Obamacare has been summarized by the Heritage Foundation, which outlined how the legislation detrimentally affects Americans:
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“Seniors: The law cuts an estimated $716 billion from Medicare over ten years. However, these “savings” are not set aside to preserve Medicare’s future, instead they are used to fund new spending created by the law. Nearly one-third of all seniors rely on Medicare Advantage, the private health care option in Medicare. Despite the program’s growing enrollment and beneficiary satisfaction, Obamacare makes deep cuts to the program that jeopardize its viability in coming years. In addition to payment cuts, Obamacare imposes new taxes on drug companies and medical device makers, and new regulations that will make health care more costly for seniors.

“Doctors: The United States is facing a severe physician shortage. By 2020, the nation will need an additional 91,500 doctors to meet medical demand. Obamacare exacerbates this problem by further increasing physicians’ workload and worsening their attitudes regarding the health care system. A 2012 survey found that Obamacare is motivating doctors to change their retirement timeline, with 43 percent of respondents stating that they are considering retiring within the next five years as a result of the law.

“Business & The Economy: The Congressional Budget Office estimates that the Obamacare subsidies will discourage Americans from working, and cause 2.5 million employees to drop out of the labor force.Obamacare’s employer mandate will raise the minimum cost of hiring a full-time worker to $10.30/hour in 2015. Congress has already raised the minimum wage from an employer’s point of view, but the money goes to the government instead of the employees.

“States: Obamacare’s Medicaid expansion worsens the already heavy burdens facing states. By 2021, approximately 78 million people are projected to be enrolled in Medicaid—requiring billions of dollars from state budgets and taxpayers. In the individual market, Obamacare’s exchanges have on average decreased insurer competition by an estimated 29 percent nationwide. Furthermore, over half of the counties in the U.S. have only one or two insurers to choose from in their Obamacare exchange.

“Families: Obamacare adds nearly $2 trillion in new health care spending according to the Congressional Budget Office. Over the next 10 years, Obamacare will levy about$771 billion in new taxes and fees. Obamacare imposes significant financial penalties on the decision to get or remain married – over $10,000 per year for certain couples.

“Uninsured: The Congressional Budget Office estimates that “between 6 and 7 million fewer people will have employment-based coverage each year from 2016 through 2024 than would be the case in the absence of [the new health law].”In 2024, after ten years of full implementation, 31 million people are projected to remain uninsured.”

The Report Concludes on Monday