Obama: repeal and delay “is, simply put, irresponsible”

President Barack Obama has penned a sharply worded editorial in the New England Journal of Medicine defending his signature legislative accomplishment, the Affordable Care Act — and criticizing Republicans’ repeal-and-delay strategy that would effectively scrap the law before Congress agrees on how to replace it.

“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,” Obama writes in the article, his second this year in an academic medical journal. “If a repeal with a delay is enacted, the health care system will be standing on the edge of a cliff, resulting in uncertainty and, in some cases, harm beginning immediately.”

This is the first time the president has commented on Republicans’ strategy toward Obamacare repeal. It comes two weeks before he leaves the White House, one of his last chances to defend the Affordable Care Act’s health overhaul while still in office.

There is political appeal for Republicans in their idea to repeal the Affordable Care Act and set up a deadline two or three years in the future: It would allow them to immediately fulfill a central campaign promise GOP candidates have made for years, without enduring the long and difficult task of mustering the bipartisan votes necessary for a replacement law.

Obama contends that chain of events would introduce significant uncertainty into the health care system. Even though the law’s programs would stay the same on paper, as repeal wouldn’t take effect until the replacement plan passed, the president believes many parts of the health care system would start acting differently:

If a repeal with a delay is enacted, the health care system will be standing on the edge of a cliff, resulting in uncertainty and, in some cases, harm beginning immediately. Insurance companies may not want to participate in the Health Insurance Marketplace in 2018 or may significantly increase prices to prepare for changes in the next year or two, partly to try to avoid the blame for any change that is unpopular.

Physician practices may stop investing in new approaches to care coordination if Medicare’s Innovation Center is eliminated. Hospitals may have to cut back services and jobs in the short run in anticipation of the surge in uncompensated care that will result from rolling back the Medicaid expansion.

Employers may have to reduce raises or delay hiring to plan for faster growth in health care costs without the current law’s cost-saving incentives. And people with preexisting conditions may fear losing lifesaving health care that may no longer be affordable or accessible.

Obama’s critique echoes concerns voiced by both liberal and conservative health policy analysts. They expect that repeal and delay could push Obamacare’s marketplaces — already showing signs of instability — into free fall.

“Without rapid action to stabilize the exchange markets, we are likely to see more insurers dropping out and another round of sharply increasing premiums,” Joe Antos and James Capretta, health policy experts at the conservative American Enterprise Institute, predict.

“Repeal and delay would be a terrible policy to adopt,” says former Congressional Budget Office director Doug Elmendorf. “Passing it will badly damage the health care system. It would make far more sense to wait until the actual alternative is written.”

Ezra Klein and I will likely discuss this article and much more in our interview with President Obama today, which you can watch live on Vox at 11:10 am Eastern.