摘要：We describe the patterns of coverage gains associated with the Affordable Care Act (ACA) expansions and use these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. We find that specific provisions of the ACA, including the Medicaid expansion and the structure of premium subsidies, have been associated with large and robust gains in insurance coverage. We evaluate the impact of retaining dependent coverage and high-risk pool provisions and show, on the basis of the ACA experience, that these provisions would have little effect on coverage. We find that many replacement proposal components, including flat tax credits and maintaining cost savings provisions, could jeopardize the ability of many of the ACA’s primary beneficiaries, as well as other Americans, to access coverage and care. By leading to a deterioration of the safety net, these strategies could also imperil population health activities. The Republican administration intends to repeal the Affordable Care Act (ACA; Patient Protection and Affordable Care Act, Pub L No. 111-148, 124 Stat. 855 [March 2010]) and replace it with an alternative. Such a change could have substantial effects on coverage and access to care and on the public health system. The simplest repeal of the ACA would undo it entirely and return health insurance coverage more or less to where it was before the ACA’s passage, when 16% of Americans were uninsured. 1 Some critics of the law have proposed replacements that retain some popular provisions. 2 The effects of such a partial repeal depend on the details. We use what has been learned from the experience of the ACA expansions to assess the potential impact of alternative repeal and replace strategies.
