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GOP's 'Obamacare' repeal path worries health care industry

Dec. 9, 2016 at 8:28 p.m.

FILE - In this Oct. 24, 2016, file photo, the HealthCare.gov 2017 web site home page as seen in Washington. One by one, key health care industry groups are telling the incoming Republican administration and Congress that it’s not a good idea to repeal the 2010 health care law without clear plans to address the consequences.  (AP Photo/Pablo Martinez Monsivais, File)

WASHINGTON (AP) - One by one, key health care industry groups are telling the incoming Republican administration and Congress that it's not a good idea to repeal the 2010 health care law without clear plans to address the consequences.

Hospitals, insurers and actuaries - bean-counters who make long-range economic estimates - weighed in recently, and more interest groups are expected to make their views known soon. Representing patients, the American Cancer Society Cancer Action Network reminded lawmakers that lives are at stake.

The concerns go beyond the obvious potential hardship for 20 million people covered by subsidized private insurance and expanded Medicaid under President Barack Obama's signature law. Hospitals say a stand-alone repeal would cost them billions, compromising their ability to serve local communities. Insurers say Congress must be careful not to create even more uncertainty and instability. Actuaries worry that the mere promise of an eventual replacement won't be enough to sustain the individual health insurance market.

And the anti-cancer network is concerned that protection for people with pre-existing health conditions might be undermined or lost. Before the Affordable Care Act, it was common for insurers to deny coverage to people with a cancer diagnosis, even if successfully treated, or to charge them more. Also, uninsured people with cancer are more likely to be diagnosed late, when there's less chance of a cure.

"Replacement health care legislation that accompanies repeal needs to provide recognized patient protections that currently exist," Chris Hansen, the group's president, said in a statement.

Republicans say they remain resolute in their determination to repeal "Obamacare," but some also seem mindful of the potential political risks.

The basic plan under GOP consideration involves repealing the health law next year, but delaying the effective date to allow Congress time to pass a replacement. That replacement presumably would do many of the things the Affordable Care Act does, such as subsidizing coverage and protecting people in poor health, but with less government regulation and without the unpopular "individual mandate" for most Americans to have coverage or risk fines.

However, replacement legislation that covers a comparable number of people would still require billions in government financing and extensive regulations, a stumbling block for the most conservative Republicans.

The path forward is complicated by the dynamics of the 2016 political campaign, which centered on personalities rather than policy. President-elect Donald Trump promised to repeal "Obamacare," but his ideas for a replacement plan were more talking points than an actual plan.

"Public opinion seems to be shifting," said John Rother, president of the National Coalition on Health Care, an umbrella organization that includes doctors, businesses, unions, and religious groups. "It's not clear when people say they want to 'repeal,' what they mean by that. It may mean they just want to get rid of the individual mandate."

Rother believes the outcome ultimately hinges on a handful of GOP senators. "Moderate Republicans are worried about the consequences," he said. His coalition has written Congress to express its concerns.

Industry groups are giving lawmakers plenty to consider:

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