Republicans have been eager to repeal the Affordable Care Act ever since President Barack Obama signed it into law in 2010. Soon, they’ll have the power to do it, and they’ve already laid the groundwork for a quick repeal.
Their current strategy appears to be a quick repeal vote with a future date — several years in the future — for it to become effective and replaced with a different, as yet unknown, plan.
Setting aside the reality that repeal is absolutely wrong, Republicans are pursuing a faulty, fantasy-based strategy for achieving their damaging goal.
The fundamental problem with their approach is that once insurance companies know the Affordable Care Act is going away, they would have no incentive to continue to write plans that comply with the act. As a result, the ACA would essentially be dead and the insurance market in turmoil as soon as the repeal vote takes place. That will leave Americans who buy insurance on the individual market without their current best, and often only, option for affordable and useful insurance coverage.
Politically, Republicans are scrambling to find ways to avoid blame for this meltdown.
“Number one thing [Republicans] have to avoid is putting themselves in a position where Democrats can frighten people — that somehow, they won’t have access to health care because of Republicans,” former House Speaker Newt Gingrich, a close Trump ally, told CNN.
A more basic problem is that many in the GOP, including President-elect Donald Trump, have adopted the narrative that the ACA has been a disaster. It has not been.
Since the law’s passage, 20 million Americans have gained health insurance through the act’s provisions. The percentage of Americans without health insurance has been cut nearly in half, from 16 percent in 2010 to 8.6 percent last year. The decrease in the number of uninsured has been most dramatic among low-income Americans, with a 36 percent reduction among those who earn 138 percent of the federal poverty level.
That means millions of people can now regularly see a doctor rather than waiting until health problems become crises that draw them to the emergency room. This improves lives and saves people money.
More than a quarter of American adults under the age of 65 have pre-existing conditions, such as high blood pressure, diabetes, asthma or cancer. Before the ACA, these people could be denied coverage or charged more. In Maine, 229,000 adults have conditions that would allow insurance companies to deny them coverage without ACA protections, according to analysis by the Kaiser Family Foundation.
By extending health insurance to more Americans, hospitals also benefit. The cost of uncompensated care — treatment a patient is unable or unwilling to pay for — has dropped significantly as a percentage of hospitals’ overall budgets. It was cut in half in states that expanded Medicaid coverage. Maine was not among those states.
The reality of losing their health insurance is scaring many Americans, including some who voted for Trump. “I guess I thought that, you know, he would not do this, he would not take health insurance away knowing it would affect so many people’s lives,” Debbie Mills, an Obamacare enrollee in Kentucky who supported Trump, told Vox. “I mean, what are you to do then if you cannot pay for insurance?”
Mills’ husband is on a waiting list for a kidney transplant, which they cannot afford without health insurance.
For these reasons, some Republicans are wary of a quick ACA repeal without a replacement to put in place at the same time.
Sen. John McCain, for example, told reporters this week that he supports a slower approach to repealing the law. He said he is “always worried about something that took a long time in the making and we’ve got to concentrate our efforts to making sure that we do it right so that nobody’s left out.”
Sen. Susan Collins voiced similar concerns last month. “You can’t just drop insurance for 84,000 people,” Collins told the Portland Press Herald, referring to the number people who have signed up for ACA insurance in Maine.
Sen. Angus King opposes a repeal and has joined moderate Democrats in calling for reasonable bipartisan changes to the law rather than a wholesale gutting. He has also co-sponsored an amendment to stop fast-tracking of an ACA repeal.
The ACA is far from perfect, but it has extended insurance coverage to tens of millions of people who need it. Rather than fulfill a vendetta-driven political agenda, Republicans leaders should slow down and realize that an Obamacare repeal won’t just harm their constituents, but also their political futures.
Fixing the Affordable Care Act is a much more prudent path to take.