Within just a few hours Tuesday, Senate plans first to replace—and then to simply repeal—the Affordable Care Act, quickly fell apart.

Despite the failures, it's clear there's still a bull's-eye on the ACA.

President Trump is pushing another strategy for overhauling health insurance: letting the law die of neglect. As he tweeted earlier today, "Let Obamacare fail, and then come together on a great healthcare plan. Stay tuned."

A Slow Death

There are a number of ways that the Trump administration could undermine the existing law, possibly causing it to collapse, eventually leaving consumers with few affordable, comprehensive health insurance options, according to Sara Collins, vice president of health care coverage and access at the Commonwealth Fund, a nonpartisan foundation that supports independent research on health and social issues.

For example, the administration could: 

  • Refuse to fund key subsidies that insurance companies rely on, driving them out of the market or pushing premiums so high that people couldn't afford to buy insurance. A Commonwealth Fund analysis found that if those subsidies, known as cost-sharing reductions, aren't funded, it could destabilize the insurance market.
  • Fail to enforce the penalties against people who currently don't buy insurance. That might drive healthy people out of the insurance market, leaving insurers only with sick—and costly—customers.
  • Stop outreach programs designed to encourage people to sign up for health insurance.
  • Grant waivers to states allowing them to bypass key protections in the ACA, such as providing comprehensive health insurance or limiting out-of-pocket costs consumers must pay.

Those actions—or in some cases, inactions—could lead to millions of people with few, if any, affordable health insurance options, says Chris Sloan, a senior manager at Avalere Health, a healthcare consulting firm.

Republicans in both chambers say changes are necessary to the nation's healthcare law to reduce the price of premiums and to give states the flexibility to offer Americans more affordable healthcare options.

They say the ACA already is buckling under the weight of rising premiums for plans offered on the healthcare exchanges. And they point out that in some counties across the nation few or no options are available as insurers withdraw ACA plans.  

The House passed its version of repeal and replace legislation in June, and the Senate has been trying to come up with a plan that enough senators would support.

But as of Tuesday, a unifying piece of legislation among Senate Republicans seemed out of reach, even one that would simply repeal the ACA. 

Meanwhile, Democratic congressional leadership has called for a bipartisan approach to fixing the ACA. 

How Repeal Could Harm Consumers

If efforts to outright repeal the ACA, as Senate leader Mitch McConnell advocated for Tuesday, are somehow resurrected, it could lead to an even quicker demise for the ACA.

“A partial repeal bill would produce an actual, real-life death spiral,” says Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonprofit that focuses on healthcare issues.

Read More About Healthcare Reform

“This path to repeal is just as dangerous as the Senate’s replacement plan,” says Betsy Imholz, special projects director for Consumers Union, the policy and mobilization arm of Consumer Reports. “The uncertainty created by Congress has scared off insurers, hurting the marketplace and consumers in real time. Repeal of the Affordable Care Act without any replacement plan would trigger a financial, medical, and public health crisis.”

In January, as the Trump administration took office and calls to repeal the ACA were revived, the Congressional Budget Office analyzed that 2015 repeal legislation.

Here’s how it would affect insurance coverage and costs for consumers, according to that CBO analysis:

  • More uninsured people. The number of uninsured would jump to 18 million in the first year that repeal was implemented. Within 10 years, the number of uninsured would grow to 32 million. That’s 10 million more than would be uninsured under the Senate plan. Among that group would be 14 million people who previously got insurance through the ACA's expansion of Medicaid and 9 million who could no longer afford to buy insurance because of the loss of federal subsidies.
  • Much higher premiums. People who buy insurance on their own would see their premiums rise an average 20 percent to 25 percent in the first year and increase by 100 percent within a decade.
  • Far fewer insurers offering plans. The prospect of fewer customers and higher-than-expected healthcare costs for people who remain in ACA plans would prompt many insurance companies to stop selling plans to individuals entirely. In fact, the CBO estimates that three-quarters of Americans would live in areas where no insurer sold plans on the individual market.