Uncertainty about the future of Obamacare under a Trump administration might "spook" insurers and prompt them to leave the market early to avoid losses, Politico reported on Monday, which could spell chaos for consumers who are already facing a turbulent healthcare landscape.

Vice President-elect Mike Pence confirmed on Sunday that President-elect Donald Trump would prioritize repealing the Affordable Care Act (ACA) right "out of the gate."

GOP lawmakers have said their repeal plan will give the ACA's 20 million users a year or two to find alternative coverage before the plan is phased out. But, as Politico's Adam Cancryn and Paul Demko write, "repealing the law without a replacement is likely to spook health insurers, who might bolt from the markets prematurely to avoid losses as some people stop paying their premiums, while other people rush to have expensive medical procedures before losing coverage."



"If they don't get this right, a lot of people will suffer."





Cancryn and Demko write:

Even if Congress delays immediate action to kill the health care law, Obamacare insurers would have just a few months to decide whether to stay in the law's marketplaces for 2018. Deep uncertainty about the Republicans’ Obamacare replacement could drive out those companies, cutting off insurance for, potentially, millions of customers.

Washington state insurance commissioner Mike Kreidler, a Democrat, told Politico, "The discussion right now about repeal and replacement is making the market very, very nervous. I would not be surprised to see the potential for a stampede to exit the market."

All this comes amid an already-unreliable insurance landscape. Over the weekend, the New York Times reported on a study which found that even families with insurance are having trouble finding healthcare coverage—meaning that fully one in four children in the U.S. did not have access to essential services, despite record numbers of young people having insurance.

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The Times's Marc Santora writes:

As President-elect Donald J. Trump, a Republican, vows to repeal some, if not all, of the Affordable Care Act, which extended health care coverage to an additional 20 million people, the report's authors worry that even more children could have trouble receiving the care they need. "The fact that more than 20 million children in the U.S. experience insurance and noninsurance barriers to getting comprehensive and timely health care is a challenge that needs to get the highest-priority attention from the new administration," said the report's lead author, Dr. Irwin Redlener, president of the nonprofit Children’s Health Fund and a professor of pediatrics and health policy and management at Columbia University.

"The findings reveal a system in which getting quality care is often confusing and expensive, with even those who benefit from government programs often becoming deeply frustrated," Santora explains. "For the insured, affordability is still an issue...The average deductible for an individual with health insurance was 5 percent of median income in 2013, up from 2 percent in 2003, the report said."

The lack of access creates medical debt, which further fuels the "vicious cycle," the report by the Children's Health Fund states. Of the 20.3 million youths that are currently going without "access to care that meets modern pediatric standards," 14 million live in areas with a shortage of healthcare professionals. According to federal standards, that means there is less than one primary doctor for every 3,000 people, the Times notes.

"The Affordable Care Act sought to address that problem by expanding the National Health Service Corps, but 65 percent of rural areas still have shortages of health professionals," Santora writes.

Ceci Connolly, CEO of Alliance of Community Health Plans, told Politico that one year is unlikely to give people enough time to find alternative care options. "It would be critically important to have sufficient transition time, and I doubt that one year is enough," she said. "It's enormously important for the incoming administration and Congress to be very clear about their intentions, because the worst thing for business is uncertainty."

Ian Morrison, a healthcare consultant and health system adviser, told the Los Angeles Times on Monday, "There is significant risk of chaos. If they don't get this right, a lot of people will suffer."