In the coming Congressional session in the new year, it is expected that a lot of time will be spent on health care with a special focus on repealing and possibly replacing the Affordable Care Act (ACA), also known as Obamacare.

According to a December 2016 report by the Urban Institute, 685,000 Virginians stand to lose their health insurance if a reconciliation bill passes Congress and is signed by the President.

Only bills that have federal budget implications may be considered under the reconciliation process. In this process, the Senate filibuster rules do not apply, so only a simple majority of U.S. Senators (51) need to approve the bill for it to pass the chamber. Since the U.S. House of Representatives has passed similar ACA repeals in the past, and the makeup of this chamber has not changed much, it is expected that they will also pass the reconciliation bill.

This also means that only parts of the ACA will be affected by the reconciliation bill — the parts that have federal budget dollars attached. These items, specifically, Medicaid expansion, tax subsidies for Marketplace plans, and individual and employer mandates for coverage, would be in danger.

If the federal government repeals these things, it is anticipated that many healthy people will cancel their health insurance. Other people who rely on subsidies to pay their premiums may also cancel their insurance since it will be more expensive and unaffordable for many lower-income individuals and families. This will cause premiums for health insurance to go up.

Additionally, there is no current plan to reinstate hospital reimbursements at the federal level, and with more people becoming uninsured, hospitals will have to make decisions as to who qualifies for treatment under the Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals to treat emergencies and women in labor regardless of ability to pay. Hospitals will also make decisions on whether to stay open — doing so will require increasing “indigent” or “charity” care, which will be passed along to the insured patient in the form of higher costs. Hospitals may also opt to reduce staff to minimum levels, compromising care, to save money.

Congress has no current viable plan to address these concerns. Virginia Organizing, along with many other state and national groups, wants to see improvements made to the current law that would lower premiums, lower deductibles, lower prescription drug costs, and increase access to doctors and hospitals.

Congress can lower costs by giving everyone the option of an employer-sponsored plan or Medicare. They can also negotiate lower prescription drug costs by using the low prices that Medicare and Medicaid pay for those drugs as the standard.

We cannot afford to go backwards on health care. Doing so puts other social programs and people’s lives at risk.