This week, Senator Mitch McConnell (R-KY) dropped the “replace” part of his promise to “repeal and replace” the Affordable Care Act (ACA). He failed again to convince Republicans (let alone Democrats) that his latest version of the legislation delivered better quality, affordable, and accessible health care. McConnell recently announced he will force senators to vote next week on repealing key parts of the ACA with only the vague promise of replacing them later.

This strategy is cynical. We now know from the multiple versions of the bill this year what the best Republican replacement plan looks like. The latest replacement plan is half as popular as the ACA and opposed by governors of both parties. The claim that a partisan plan would get better with time—after seven years of promises—defies logic and recent history, as the charts below show.

Republican’s plan to repeal now and figure out a replacement plan later is also harmful according to the Congressional Budget Office (CBO). CBO newly analyzed the effects of H.R. 1628, the  “Obamacare Repeal Reconciliation Act of 2017,” which the Senate will vote on next week. CBO projects that the bill would immediately drive up individual market premiums by 20 to 25 percent and cause 17 million people to lose coverage. CBO states, “Although most of those reductions in coverage would stem from repealing the penalty associated with the individual mandate, CBO and [the Joint Committee on Taxation, or] JCT also expect that insurers in some areas would leave the nongroup market in 2018.” By 2026, such premiums would double, three out of four Americans would have no individual market plans to choose from, and 23 million of the 25 million people with individual market coverage would lose it. The effects on Medicaid would also be dramatic.

The following five charts illustrate how the Republican repeal legislation has gone from bad to worse on the key measures of coverage and cost, according to CBO estimates.1

Figure 1. The repeal-only bill would result in 32 million uninsured Americans by 2026—that’s one-third more than any previous version of the Republicans’ bill.

Figure 2. The June Senate bill and repeal-only bill would be worse for Medicaid coverage than the House-passed bill.

Figure 3. A repeal-only bill would strip one-third more federal financial assistance from coverage than the latest version of the Senate bill.

Figure 4. Every version of the Republican bill would cause individual market premiums to rise by at least 20 percent next year.2

Figure 5. The repeal-only bill would leave half of all Americans with no individual market health plan options in 2020 and millions more would lose access to Medicaid.

Risk assessment based on the authors’ analysis of CBO projections and 2017 insurer participation by county and medicaid expansion status by state.

EDITOR’S NOTE: This commentary has been updated following the July 19, 2017 release of a new estimate from CBO on the projected impacts of H.R. 1628, the ObamaCare Repeal Reconciliation Act of 2017. The previous version of this post used the CBO score on the 2015 ACA repeal bill (H.R. 3762).



  1. The CBO estimates of H.R. 1628 to date were published on: March 13, 2017 (First House Bill), May 24, 2017 (Final House Bill), June 26, 2017 (June Senate Bill). Estimates for H.R. 3762 were published on January 4, 2016 and January 17, 2017 (2015 Repeal Bill).
  2. While CBO estimates that average premiums in the individual market will fall starting in 2020 under the June Senate bill, this would primarily be because of higher cost sharing, reduced benefits, and fewer older and high-cost enrollees. A Brookings Institution analysis that controlled for these factors found that the June Senate bill would raise premiums by 9 percent in 2026.