Who knows what the Republicans will propose after they repeal the ACA? One hint: look at what they say they will replace it with.
The bullet points below are taken from the current GOP "replace" plan called "A Better Way". They've had seven years of hating Obamacare to put this alternative plan together, and this is the current state of the art version.
1. Remove the "guaranteed issue" clause so people with pre-existing conditions can be denied private insurance, then provide federal dollars in support of high-risk pools for people denied coverage because of pre-existing conditions. Trump has waffled on this point, but this is what the Republicans in Congress want.
This plan just redistributes how the deficit will be used to pay health insurance companies, giving it to them through a concentrated sub-market of sick people instead of giving it to them distributed over all buyers. Unless we increase deficit spending on healthcare, this will increase costs for healthy people (by reducing the average subsidy) while potentially lowering costs for sick people. This seems like a backwards incentive to me, like Uncle Sam saying "it's okay to be an overweight smoker, we've got your back." High risk pools have consistently failed everywhere they've been tried, but we can make anything pencil out if we throw enough deficit spending at it.
(As a side note, I should mention that every penny of the ACA was paid for with new taxes and spending cuts. Democrats showed an uncharacteristic level of restraint on that one, and the cost-controls reduce future deficits, but I don't expect a Republican-controlled Congress to follow suit. I'm expecting radical new deficit spending for the next four years.)
2. Remove the individual mandate, which hurts insurance companies because they will lose customers. But not to worry, those companies can be soothed with higher government subsidies for healthcare.
All the insurers care about is their bottom line staying in the black, so as long as the GOP plan keeps them profitable without an individual mandate, they'll be happy. Millions of Americans will lose insurance, though. Under the ACA, the individual mandate is used to offset the costs of "guaranteed issue", so in theory you can repeal them both and end up with the same costs to taxpayers, but fewer people who have insurance. Or you can keep the same number of people insured by increasing deficit spending to prop up insurer profit margins. The ACA is the lowest-cost fix to get the most people insured, which is why Republicans proposed it in the first place.
3. Segregate health insurance regulations down to the state by state level, removing federal protections and letting each state decide what rules to enforce. This includes passing continuous coverage protection so you don't get dinged for losing coverage when you switch between insurance plans (just like employer plans currently have under HIPAA).
Note that this is NOT the same as the oft-touted GOP line about "buying insurance across state lines." Insurers can already sell insurance across state lines, but most of them don't because it's not cost effective for them.
This suggestion is purely an attempt to shrink the federal regulatory framework that keeps fraudulent insurers from selling garbage insurance and then refusing to pay claims, instead letting each state bear responsibility for keeping insurers solvent and effective. Some states (CA, MA, TX) can totally do this. Some states (WY, MS, AL) will fail miserably, and some of their residents will get screwed. I feel like regulating markets is one of those things that is better done federally, for the protection of people who live in shitty states, but if they really want to screw over poor red states I'm inclined to let them.
4. Expand access to HSAs by making them available to everyone regardless of plan type, giving them higher contribution limits, and allowing more more costs (like OTC medications) to be deductible.
This is a plan I could maybe get behind! We have an HSA, and we love it. It's a great tax shelter for rich folks like me, though I admit it is totally worthless to the majority of Americans who already pay little or no taxes and who don't have any surplus income to sock away in a tax shelter. This bullet point is effectively just another tax cut for the rich. Hey I'm rich, sign me up! The GOP thinks that all you poor folks can suck it, apparently.
5. Provide "refundable advanced tax credits" for people without employer insurance, regardless of income.
This is just like the ACA plan except they're calling them "credits" instead of "subsidies" but the idea is the same. Uncle Sam will foot the bill for some portion of your insurance coverage (though they would shutter the exchanges that currently allow you to shop for insurance, so get used to calling around for rate quotes). The key difference here is that under the GOP plan, Uncle Sam will provide that subsidy to everyone, instead of just for poor people. This bullet point is effectively just another tax cut for the rich. Hey I'm rich, sign me up! The GOP thinks that all you poor folks can suck it, apparently.
6. "Enact medical liability reform"
This is a meaningless phrase, without some specifics. Any state can already do this at any time, and several states already have. For example by placing maximum caps on jury awards for malpractice cases, so you only get a quarter million instead of a million dollars if a doctor removes the wrong kidney by mistake. Unfortunately, these changes don't seem to make any difference in the cost of insurance in the states that have done it. It's a fine idea, but it doesn't provide anyone with insurance or reduce anyone's costs.
7. Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.
The ACA caps the ratio of max to min premiums at 3:1, so that old folks can never pay more than 300% as much as young healthy folks pay. The GOP plan wants to change this ratio to 5:1, effectively transferring the cost of coverage away from the young and onto the old. The GOP thinks all of you poor old folks can suck it, apparently.
8. Change Medicaid to block-grant funding. This fundamentally alter the nature of this program from an entitlement, available as a social safety net to anyone who meets the criteria, to a blank check for each state to spend as they see fit. Maybe they'll expand coverage to pregnant women and children (WIC), or maybe they'll cancel medicaid entirely and use the money on tax breaks for rich people. Each state would get to decide. Red states have been pushing hard to reduce medicaid eligibility, because they don't like helping poor people.
Medicaid is currently the country's largest single insurer, providing low-cost insurance to tens of millions of low-income families and people with disabilities. It's also one of the most expensive things our government does.
Most Democrats strongly oppose ending this 54 year old program, in part because the GOP plan to dismantle medicaid (which benefits the poor and disabled) is just the first step in their plan to also dismantle medicare and social security (programs that benefit senior citizens). The GOP hates all of the entitlement programs, and medicaid is the easiest one to attack because poor people and the disabled don't vote with quite the same power that senior citizens do.
If they successfully kill medicaid, everyone's retirement plans are about to get a lot more complicated.