Repealing without simultaneously replacing also will affect the work that physicians do if recent innovations in care coordination are disrupted, he said. He warned that hospitals will cut jobs and cut back services due to anticipated cuts to Medicaid expansion.

Job security will be another casualty of repealing without replacing, he said, with employers expected to freeze wages and hiring to account for rising health-care costs.

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The former president cautioned Republicans to take a careful, evidence-based and bipartisan approach to improving the health-care system. 

He also warned of the possibility that a post-repeal vote on a replacement law could never take place.

“This approach of ‘repeal first and replace later’ is, simply put, irresponsible — and could slowly bleed the health-care system that all of us depend on,” Mr Obama said.

Given the myriad of possible negative outcomes from the Republicans’ plan to repeal the ACA, Mr Obama offered some final words of advice.

“Health-care reform isn’t about a nameless, faceless ‘system,’” the former president wrote. “It’s about the millions of lives at stake. Policymakers should therefore abide by the physician’s oath: ‘first, do no harm,’” he concluded.


Obama BH. “Repealing the ACA without a Replacement—The Risks to American Health Care.” The New England Journal of Medicine. 2017; 376:297-299. doi: 10.1056/NEJMp1616577 

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