Most of the large carriers will likely pull out of the exchanges. Those members are already unprofitable and it will be made worse as even fewer healthy people will sign up. This will cause two issues. The people remaining on the market will have their prices driven up, and they will have even fewer options.
The smaller insurance companies, regional sized, will likely try to stay on the exchanges, but it will be hard.
In two or three years, the Republicans will try to push through a plan that doesn't restrict margins as the ACA does. That will cause insurance rates to rise even faster.
This will cause fewer people to be able to afford to take the risk to start a new business, or join a new business as then they wouldn't have affordable health care.
Additionally if they follow the Pence plan, requiring continuous coverage to cover preexisting issues, will likely cause the individual market plans to go up higher.
The plan will roll back medicare and medicaid expansion in the states that were willing to do so. Those people will go back to not having as much or any coverage. They will still get sick and injured, and unless the plan is to allow hospitals to turn sick people away, that will drive up hospital costs. And because the ACA repealed payments from insurance companies to hospitals to cover the uninsured, that cost will come from the magic money fairies or something.
Say goodbye to coverage for birth control, but obviously not for viagra, because lets face it, vaginas need government control.
And then there is the plan suggested by the HHS nominee, Tom Price.
He's against protections for LGBT and domestic violence victims, not to mention women's reproductive services, because again, vaginas not under explicit government control are a extinction level threat to life on earth.
His basic plan is HSAs for everybody, which doesn't work for those who are on the exchanges and subsidized or on medicare, since they don't have money to put away and tax credits, again a benefit that mostly goes to the wealthy.
His plan would basically push health care out of reach for poor and moving into the middle class. But the tax credits are based on age. The youngest would get the least credit. Which in theory makes sense, but if you're a person with a chronic condition, you're screwed. Hope you don't have diabetes or hepatitis or something.
He would reduce what insurance plans are required to cover. So younger healthier people would be incentivized to buy a cheaper plan, driving up the costs for those who are on more comprehensive plans because healthier people aren't on the plans to level out the risk.
In short, either approach will cause premiums to spike, insurers to pull out of the exchanges and people to have worse options.
I think the best hope is that Republicans try to get smart and put the repeal and replace to a 3 year period. That way it's pushed out past the 2018 elections, but the insurers will already be pulling out, starting the problems that would then let us present the alternative in the 2018 elections. It would minimize the number of people who would be harmed.
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