Health

Kentucky Sen. Rand Paul said Wednesday that he would not vote to repeal the Affordable Care Act, known to many as Obamacare, without voting for a replacement plan on the same day. He made the comments on MSNBC’s “Morning Joe.”

“Here’s the great irony, this week we’re going to vote on a budget,” he said. “Everybody is hot and heavy to vote on this budget because they want to repeal Obamacare. But the budget they’re going to introduce will add $8.8 trillion to the debt over the next 10 years. So I told them look, I’m not going to vote for a budget that never balances.”

Paul formed the Senate’s first Tea Party Caucus and has said balancing the budget should be a more important priority than doing away with the Affordable Care Act. On Thursday, he met with members from the House Freedom Caucus to drum up opposition to the repeal if there’s no immediate replacement plan.

Congress is currently examining a process to repeal parts of the law, including the individual and employer mandates that say individuals must have health insurance, and that large employers must offer it to employees. If the bill is approved, these provisions would go away immediately.

The Medicaid expansion program and subsidies for people to buy insurance on the individual market would go away in 2019 or possibly after under the GOP plan. The part of ACA that keeps insurers from barring people with pre-existing conditions from coverage, and other consumer protections, wouldn’t be touched.

The reason why it would cost so much money, as Paul said, is Republicans don’t have a replacement plan.

Budget Buster

Imagine all the money that went into paying for Medicaid expansion, the subsidies and all the other little parts you have never even heard of – as a pie.

Most of the money pie are taken up by paying for the new people on Medicaid expansion and for people with subsidies for marketplace coverage. But those programs were paid for with new taxes on the health care sector.

So you get the money from the pie back, but then that has to go toward making up for the loss of those taxes.

The $8.8 trillion figure comes from a report by the Committee for a Responsible Federal Budget, a non-partisan public policy think tank.

“Repealing the entire ACA would leave no funds available for ‘replacement’ legislation, and in fact would require” lawmakers to come up with other ways to save money to not contribute to the national debt, the group says.

Under repeal, 30 million more people would become uninsured by 2019, which is higher than the uninsured population pre-health law, according to the Urban Institute’s analysis of the budget resolution that would do away with the law.

Health policy expert Edwin Park said what is likely to happen if this repeal goes through without a replacement is the collapse of the insurance market.

“You’d have consumer protections like the prohibition against denying coverage with people with pre-existing conditions remaining in place, but at the same time no subsidies to buy coverage in that market, no individual mandate,” said Park, who is vice president for health policy at the Center on Budget and Policy Priorities, a liberal research and analysis group. “As a result, the only individuals who are likely to enroll are likely those who are sickest.”

Paul echoed that sentiment on “Morning Joe.”

“There are many health care analysts who are predicting bankruptcy for insurance companies and a massive insurance company bailout within first 6 months of repeal,” he said. “Adverse selection gets worse if you get rid of the individual mandate.”

On Wednesday, Senate Democratic Leader Charles Schumer said in a news conference that Democrats have no plans to help Republicans come up with a replacement for the ACA.

“It’s not the Democrats that would be pushing 20 million people off insurance,” he said. “It’s the GOP’s obligation to come up with a proposal.”

Lisa Gillespie is WFPL's Health and Innovation Reporter.