During my career as a health lawyer, I have presented both sides of an issue to clients. When the Affordable Care Act was enacted in March 2010, I spoke to various audiences explaining the provisions and impact on their businesses – health care and otherwise. The law has many parts: insurance reform, Medicare payment reduction, fraud and abuse measures and innovations encouraging improved patient care and outcomes. In my mind, the ACA was and remains a three-legged stool – remove one leg and it collapses.

Frequently, politicians emphasize negative aspects of the ACA, speaking specifically about concerns with federal exchange premiums and individual and employer mandates. Not explained is the financial and life-changing impact of ACA repeal without an adequate replacement on Mississippians’ lives.

The most recently available data for 2017 indicates that 79,342 Mississippians are enrolled in the federal exchange. Currently, only Humana, covering 32 counties, and Magnolia/Ambetter, covering 52 counties, remain in the Mississippi market. Repeal with delayed replacement may result in these insurers leaving the exchange marketplace, a risk Mississippi cannot afford.

Mississippians with employer-sponsored insurance are also negatively impacted. ACA reforms require plans to cover preventive services without cost-sharing by new plans, benefiting more than 1.3 million Mississippians, according to the U.S. Department of Health and Human Services. The ACA eliminated the waiting period for pre-existing condition coverage. It allowed dependents up to 26 years of age to remain on their parents’ insurance, providing coverage to roughly 37,000 dependents. Loss of the ACA-required elimination of annual or lifetime limits on benefits would negatively impact 884,000 Mississippians.

Due to ACA’s restrictions on premium growth, Mississippians’ premiums are $6,000 lower in 2016 than if ACA had not been enacted. Because of the 80/20 medical loss ratio rule, insurers spending less than 80 cents of every dollar on health care refunded Mississippians over $11 million since ACA’s enactment.

Repeal without adequate replacement would eliminate services and increase costs for more than 560,000 Mississippians on Medicare. In addition to adding preventive services and an annual wellness visit with no out-of-pocket expense, the ACA reduced Medicare Part A deductible and copayments and Part B premium and deductible payments due to their being indexed to hospital payment updates. By 2020, ACA would close the Medicare Part D donut hole, a coverage gap necessitating full payment for drugs until out-of-pocket payment reaches a certain amount.

According to the Daily Journal, if the ACA is repealed, the 80,000 Mississippians added to Medicaid due to ACA-revised Medicaid eligibility requirements would lose coverage. Beyond individuals, repeal without replacement would negatively impact Mississippi hospitals, a number of which are currently failing.

While no doubt any number of ACA provisions would benefit from review and revision, the negative implications for Mississippians of an outright ACA repeal without adequate replacement are profound and necessitate careful consideration.