Last week, President Trump signed an executive order to start the nation down a path to repeal the Affordable Care Act (ACA). The president has also promised to replace the ACA with “great health care for much less money.” We have yet to see any details on either specific administrative actions or legislation to change the ACA. However, Congress previously passed a partisan reconciliation bill (H.R. 3762) that repealed some provisions of the law immediately and others in two years; it was vetoed by President Obama. This reconciliation bill will likely serve as the basis for the one that is expected to be introduced shortly, and was recently analyzed by the nonpartisan Congressional Budget Office (CBO).

CBO concluded what others have predicted: there would be no status quo under this repeal-and-delay approach. Putting aside whether Congress subsequently passes a replacement bill, premiums in the Health Insurance Marketplace would go up within a year. This is primarily because the reconciliation bill would immediately repeal the individual responsibility provision. Assuming this legislation is signed into law prior to the May 3 deadline for issuer applications for 2018 Marketplace health plans, premiums for such individual plans could increase by 20 to 25 percent over baseline increases, according to CBO. The same result could happen if the new executive order expands exemptions that effectively negate the individual responsibility requirement in the near term.

Translating CBO’s premium increases into dollar amounts, the repeal-and-delay legislation could add roughly $725 to $900 to the 2018 average annual premiums for 27-year-olds in states using The map above shows what this would mean for similar people, by state, assuming a 20 percent premium increase. Amounts range from a hike of $468 in Washington to $1,824 in Alaska. These amounts would be even higher for older enrollees, who can be charged as much as three times more than young adults for individual market coverage. And premium increases for families would be at least double this amount.

What CBO’s calculations underscore is that a “smooth transition,” with no one paying higher premiums and everyone keeping their coverage, cannot be achieved once dismantling of the health system has begun—whether it is done through executive or congressional action.

Cover Photo Source: Twitter.


  1. The estimates are calculated by multiplying (a) the CBO projected premium increase of 20 percent attributable to legislation like H.R. 3762 in the first full year after enactment by (b) the 2017 State average second-lowest silver plan premium before advance premium tax credit for a 27-year–old, as reported in Table 12 of “Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace,” Department of Health and Human Services, October 24, 2016, Premiums for states not included in this report are for the largest markets in those states, adjusted for age, as reported by the Kaiser Family Foundation, October 2016,