Republicans have started the new year taking the first steps to dismantle the health care system in the United States. The scary part? They don’t yet have a replacement for it.

On January 4th, Congressional Republicans approved debates on a budget resolution that would ultimately defund and dismantle the Affordable Care Act (ACA), colloquially known as “Obamacare,” President Obama’s signature healthcare reform bill. Republicans will undo the bill bit by bit, first removing the mandates that every American have health insurance and that companies with 50 or more employees provide affordable coverage. According to CNN, the budget resolution will then cut taxes supporting the ACA and cancel Medicaid expansion under the law.

The ACA is imperfect–premiums have increased for popular plans, some as much as 25%, and there is no public option available for the most vulnerable populations. In addition, the number of healthcare plans in health insurance marketplaces have decreased in some states, leaving people with fewer options for insurance.  

However, according to the Department of Health and Human Services, around 20 million more people have been able to be insured under the ACA. The fact that Republicans are acting so quickly to repeal the ACA without a replacement is troubling, since so many depend upon the law’s affordances to increase their access to healthcare.

The ACA enables young people to stay on their parent’s insurance until they are 26, prevents insurance companies from denying coverage due to a pre-existing condition or charging more due to gender; the law expands access to Medicare and removes lifetime limits on healthcare coverage, in addition to numerous other benefits.  

What sense does it make to repeal Obamacare? Though it is imperfect, the law is clearly meeting needs of many in the United States and filling important gaps that existed in the healthcare system. Why don’t Republicans want to improve the law, rather than dismantle it entirely?

This is part of a greater plan to diminish Obama’s legacy. Republicans have intended for years to undo the law and have attempted to repeal the ACA around 60 times in the past 8 years. Interestingly, President-Elect Trump seems to like portions of Obamacare, saying after the election (despite railing against the law on the campaign trail) that there are portions of the law that he’d like to keep—including allowing young people to stay on their parents’ plans and allowing coverage for pre-existing conditions.  

Unfortunately for Republicans, the ACA is ingrained into our healthcare system and is too complex for them to either repeal the parts they do not like or replace with a better law. Republicans have refused to face the reality of Obamacare and are now at a loss of how to fix it without dismantling the entire US healthcare system and causing instability. Republicans will not be able to repeal mandates and taxes which fund, incentivize, and stabilize the system while also, somehow, keeping coverage for those that healthcare providers are less inclined to cover.

Some Republican senators, such as Rand Paul and Tom Cotton, have come forward to express concern over a repeal without a ready replacement. According to Politico, Paul stated that “I think if you do repeal alone, the disaster continues to unfold.”

Clearly, Republicans need to do more to improve the American health care system besides making grandiose political gestures. Otherwise, their own constituents will find themselves uninsured and out of luck.

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