UA's Dr. Richard Streiffer on Potential Impact of Affordable Care Act Repeal

Feb 2, 2017

Dr. Richard Streiffer, Dean of the College of Community Health Sciences at the University of Alabama
Credit UA

The Affordable Care Act is seen as one of the defining pieces of President Obama’s legacy – and the new Republican majority has targeted it for repeal.

Leading lawmakers in both houses of Congress have begun work dismantling Obamacare – despite not having any plan in place for a replacement, and despite polling that suggests an overwhelming majority of Americans oppose its repeal without a replacement ready.

Dr. Richard Streiffer is the dean of the College of Community Health Sciences at the University of Alabama. He joins us to explain the current state of the health insurance marketplace in Alabama, what the Affordable Care Act has done for Alabama's citizens, and what it might mean for the state if the act is repealed.

Dr. Richard Streiffer: So, the notion of the ACA, or part of the notion of the ACA, was to offer health insurance options to individuals who might not have an employer offering – insurance through their employer. And there was a notion underlying it of these health exchanges, where people could go and look at various options and find one that might suit their needs better than others.

What I understand has happened is that those options have basically dried up within Alabama, as some of the insurance companies that had offered it are leaving the market, or have left the market. And in essence, there will only be one choice, and that is Blue Cross.

So the notion of choice and competition to try and improve the market has gone away in Alabama.

Alex AuBuchon: Even with the exchange troubles, I know the state has benefited from the ACA. Tell me about some of the highlights – especially for individuals.

RS: So altogether, there were well over a quarter of a million people who gained coverage in Alabama. And most of these were not the indigent. Most of them were working individuals who did not have coverage through their employer.

Clearly, we insured more people, and got them coverage in Alabama. We eliminated the pre-existing condition exclusion and the lifetime cap on benefits, so that many people who were not insurable before, or whose insurance ran out because of a serious illness, like cancer, for example, were now protected and continue to be insured.

There were tremendous extensions in coverage for recommended preventative services, screenings and so forth. We know that, in the United States, we miss at least half of the preventative opportunities, and prevention is a much more cost-effective way to improve the health of a population than only responding to existing diseases and crises. And the research on the Affordable Care Act has begun to show that, with the coverage afforded through it, people were more likely to see their doctor, not delay care, get the treatment that they needed for chronic disease, and to self-report improved health.

Those are all important benefits at an individual level.

AA: So what happens to the people who have benefitted if the ACA is dismantled without a replacement?

RS: No one can predict with precision what a repeal of the Affordable Care Act would mean to Alabama. But let’s hypothetically look at what were to happen, should it go away with no plan in place.

It’s been projected that somewhere between 250,000 and 350,000 residents of Alabama could lose their coverage, and that almost a million non-elderly Adults – that is, adults who are not on Medicare, which is guaranteed – could have what are called declinable pre-existing conditions. So if you have a chronic disease, and we lose that protection that’s in place right now of being insurable even with a pre-existing condition, you would no longer have insurance. That’s a million people.

AA: I know we’re just scratching the surface of the potential impact – but what would you say to those who believe this sort of shakeup is necessary to fix a system they see as, overall, failing?

RS: I don’t think there’s any argument that there are opportunities to improve many aspects of the Affordable Care Act. And while not all change is improvement, there can be no improvement without change.

My request for us as a society, and as a state and as a country, is to think through this in a rational way, to look at the benefits that have come and to explore the opportunities for improvement, but not throw the baby out with the bathwater. Otherwise, there will be consequences. And the consequences will not be good for individuals, or for the state.