Scott G Winterton, Deseret News
FILE— Utahns unite to march and rally in downtown Salt Lake City in support of protecting access to affordable and quality health care Saturday, June 10, 2017.

SALT LAKE CITY — Two organizations warned Monday that repealing the Affordable Care Act without legislation in place to immediately replace it is a major gamble that could cause as many as 200,000 Utahns to lose their health insurance, many of them within months of the law being killed.

The Utah Health Policy Project, a think tank and nonprofit enrollment network that helps people obtain insurance, and Voices for Utah's Children, an advocacy group that pushes for policies supporting various childhood wellness metrics, believe federal lawmakers would run a significant risk by banking on the passage of a replacement health care bill at a later date.

"Repealing the ACA without a replacement strategy is not a plan," Jessie Mandle, senior health policy advocate for Voices for Utah's Children, told KSL Newsradio's Doug Wright. "It's just a risky step that threatens the health and well-being of kids and families in our state … without a clear path forward. That's just unsafe and unwise."

Mandle's words of caution come in the wake of some Senate Republicans showing willingness in recent days to consider repealing the Affordable Care Act even if there are not enough votes to pass its proposed replacement, the Better Care Reconciliation Act.

Sen. Mike Lee, R-Utah, said last month that he has long preferred repealing the law entirely before voting on a replacement, saying doing so would be the only way to bring Democrats to the table on health care reform.

"Democrats certainly aren't going to vote for anything that's repealing Obamacare in the process," Lee said at the time.

President Donald Trump also said Friday he would be supportive of a full repeal of the Affordable Care Act before replacement legislation can garner enough votes.

Sen. Ben Sasse, R-Nebraska, also told Trump in a letter on Friday that if enough votes are not reached on the Better Care Reconciliation Act, he would support voting for essentially a repeal of the Affordable Care Act, then negotiating and passing a replacement law by Labor Day.

"We should include a yearlong implementation delay to give comfort to Americans currently on Obamacare that a replacement plan will be enacted before expiration," Sasse wrote.

Sasse's idea also has the support of Sen. Rand Paul, R-Kentucky.

But Mandle and Jason Stevenson, Utah Health Policy Project spokesman, believe that getting rid of current health care law without an established replacement is a chaotic strategy because it does nothing to guarantee Congress will be able to agree on a replacement before the Affordable Care Act's provisions expire.

"It's really the equivalent of pushing the big red button on health insurance,” Stevenson said. "It unleashes a chain of dominoes that people can theorize about and we think we know what's going to happen, but there's still a lot of unknowns. … Unknowns are terrible, no one in (the insurance) business likes unknowns."

The uncertainty over the pending health care legislation, in and of itself, is likely to contribute to rising premiums in Utah in 2018, though rates are generally lower in the state than nationwide, Stevenson said.

Insurers are expected to reveal their planned premium rates on the individual market in Utah either this summer. They're expected to be about 20 percent higher than if they had a clearer idea of what health reform might or might not pass and what federal funding might be available to them, according to Stevenson.

"Uncertainty is the killer in this business," he said. "It's just an extra bubble that insurance companies are building into their rate increases."

If there is a lapse between Affordable Care Act repeal and its replacement, the number of Utahns who could lose their insurance may be as many as 200,000, with roughly half of those people losing their insurance within the first one to two months after the repeal takes effect, Stevenson told the Deseret News.

The Congressional Budget Office estimated that, under the Better Care Reconciliation Act, 22 million fewer Americans would have health insurance in 2026, compared to current law, but didn't provide a state by state estimate. That number would be 32 million if there was no replacement to the Affordable Care Act, according to a report the office published in January.

If passed, the Better Care Reconciliation Act would result in about $772 billion in cuts to Medicaid spending by 2026, compared to current law, and reduce federal spending in total by $321 billion by that time, according to a report from the Congressional Budget Office analyzing the bill.

Under the bill, premiums on the individual health insurance market would likely rise for two years before dropping in 2020, and ultimately end up about 20 percent lower compared to current levels in 2026, according to the same report. In states that would allow insurers to exclude some benefits defined as essential under the Affordable Care Act, most buyers on the individual market "would have higher out-of-pocket spending health care than under current law," the report's findings state.