'What Do You Have To Lose?' Asked Candidate Donald Trump. Your Health Insurance, He Now Answers.

“What do you have to lose?” asked candidate Donald Trump . It now looks like he meant your health insurance. Trump’s promise to repeal and replace the Affordable Care Act (aka Obamacare) with something great doesn’t look very promising. Oh the ACA will most likely be repealed. Now that the Republicans control the entire government, they can carry out their promise and their three dozen previous attempts to do just that. But replace it with something great? Not as likely.

If you were one of the 20 million or so people who health insurance through the Affordable Care Act that passed in 2010, you have probably heard that you may forfeit the opportunity to buy insurance on a State-based or Federal “Exchange” if the ACA is repealed. The Republicans have not said how they plan to offer individuals insurance without an Exchange, other than “allowing” you to buy it on your own and let insurers sell across State lines. (Not exactly a relief…) Trump and the Republican leaders claim to like the provisions that keep adult children on their parents’ plans until they are 26 and the prohibition against rejecting pre-existing conditions. But what they are not telling you is that those provisions aren’t practical to offer on their own unless there is a requirement for everyone to buy insurance (the individual mandate), something they also want to repeal. Oops, as ex-Gov. Rick Perry would say.

So, aside from the 20 million who are anxious about losing their health insurance, if you did not buy individual health insurance through an Exchange, what DO you have to lose? If you are lucky enough to have Medicare or private insurance through your employer, you may think a repeal may not affect you. But a repeal would eliminate a few very important things for everyone with insurance:

1. Back to lifetime or annual limits on your coverage . The ACA prohibited annual and lifetime limits on what your insurer would cover. If you have ever been truly sick or been in an accident, you know that you can hit that $100,000 annual cap you used to have pretty quickly. Even a rotator cuff surgery or knee replacement can easily cost $50,000. Few people ever hit the limit each year, but the ones that did know what they will miss if those limits are removed. Removing these limits was a safeguard against medical bankruptcy.

2. No more discounts on prescription drugs through Medicare . This is a big one for seniors, and I bet there are plenty of seniors who voted for Trump without realizing that not only can he eliminate your drug discounts when he repeals the ACA, he can go along with the Republicans to “privatize” Medicare. About your prescription drugs—If you are eligible for Medicare you can purchase prescription drug coverage in three ways 1) If you are on basic Medicare without a supplement and do not sign up for Part D, you pay for your own drugs; 2) If you have a Medicare Advantage plan (Part C), drugs are included; 3) If you have Part D coverage, you get a BIG discount. About a quarter of Medicare recipients fall into the “donut hole” without coverage every year, and 85 percent of them stay there, paying thousands of dollars for their drugs. Eight million seniors have saved $11.5 BILLION on their drugs because of the ACA. The ACA has provided seniors with a 50 percent discount on brand name drugs and a 7 percent discount on generic drugs. And the donut hole has been slowly closing and was slated to disappear completely by 2020. If you have cancer and are receiving expensive drugs, the savings in the ACA have been substantial. And if you have diabetes, without the ACA, a monthly supply of two types of brand insulin could run into the thousands.

3. No more comprehensive “essential benefits.”  Under the ACA very health plan had to offer a set of “essential benefits” that were far more comprehensive than many insurance plans used to offer. Some plans did not cover physical or speech therapy; other plans only covered pregnancy care if you paid more; preventive health check ups or birth control were not usually covered either. The ACA offered every person with insurance a set of benefits that would protect you no matter what your health needs. Repealing the ACA means that you will be able to purchase a “skinny” plan that offers none of this, but god forbid you end up in the hospital or have a car accident or get an unexpected disease­­­­—your new cheap skinny plan would not cover more than a hospital gown.

There are other aspects of the ACA that would go away as well with a repeal—tax credits for small businesses that offer their employees insurance; funding for community health centers; rebates from insurers whose overhead is higher than it should be; a fraud and abuse program in Medicare that saved Medicare $2.5 Billion in 2015 alone.

What would Donald Trump and the Republicans offer you if they repeal the ACA? First, it would be very painful if they repeal without immediately offering you a replacement. Second, if the replacement is the one Trump has proposed, it would raise federal spending by $330 billion and you would likely end up more on your own with fewer benefits and more cost. So when Trump asks you “What do you have to lose?” You need to shout loud and clear: “JUST ABOUT EVERYTHING!”