What If Ryan Gets His Wish and Trumpcare Becomes Law

WASHINGTON -- The Republican's repeal and replace bill, American Health Care Act, cleared two congressional committees and the Congressional Budget Office released its scoring report, Speaker of the House Paul Ryan (R-Wisc) says passing the GOP plan is a make or break issue Congress.

So it is time to ask the pundits: what will happen if this bill becomes law? MedPage Today asked policy experts on both sides of the great healthcare divide to answer that question and this is what they told us.

From the Pro Repeal and Replace Camp:

Douglas Holtz-Eakin, PhD, president of the American Action Forum touted the bill because it allows people to make their own choice. He predicts that eliminating the individual mandate will mean 5 million fewer uninsured in 2018.

"The bill basically says we respect your decision to not purchase insurance. There's a public policy decision about how much we respect people's decisions and clearly we know where the bill comes down on that," he said.

Asked what happens to those individuals who won't be able to access Medicaid after the expansion is rolled back, Holtz-Eakin said that will depend on whatever reforms the states choose to undertake.

With the $100 billion from the Patient and State Stability Fund, states can choose to develop high risk pools, reinsurance plans or enable cost-sharing subsides to support their low-income populations.

Most conservatives reject the idea that governors will neglect their most vulnerable constituents he said.

Carrying that theme a step further: the GOP plan not only offers choice but also more choice. "They will undoubtedly have a broader choice of plan," said Diana Furchtgott-Roth, a senior fellow at the Manhattan Institute, a conservative think tank, and an adjunct professor at George Washington University.

She explained that people would have a chance to purchase plans that are tailored to their specific needs, instead of plans that cover a broad array of benefits such as pediatric dental care and maternal healthcare.

"A plan that covers everything is more expensive" she said, so this would lower costs.

Furchtgott-Roth told MedPage Today "Remember when President Obama said, 'If you like your plan you can keep it.'"

The CBO report doesn't factor in the broader range of plans, and that prices would drop due to increased competition, she said.

"It doesn't account for the fact that people are going to come flooding into the market to buy the plans that they want to buy so I believe coverage would increase rather than decrease," she said.

And Now the Loyal Opposition:

Under the Affordable Care Act, the reason everyone pays for all of the various benefits was because doing so lowered costs, explained, Diana Zuckerman, PhD of the National Center for Health Research.

In the same way that car insurance lowers the cost of having an accident when everyone buys it, under this philosophy healthcare also protects everyone who buys it, Zuckerman said.

"Under [the AHCA] it's a different view. It's not that view of 'We're all in this together,' and if we all share the cost, we'll all get good insurance. Instead the view of this plan is every person for themselves. Everybody should get what seems best for them, even though that could result in 24 million not getting any insurance."

Some of the worst effects of the AHCA relate to its impacts on older individuals in rural areas, where there isn't a lot of insurer competition to begin with said Sara Rosenbaum, JD, a professor of health policy at George Washington University

Under the Republicans' proposed bill, "if your 40 and in poor heath and living in rural Pennsylvania you're kind of out of luck" Rosenbaum said.