The Affordable Care Act saves and is a prudent investment for America
In my blog on Monday ( https://www.healthcarelabyrinth.com/what-will-happen-in-healthcare-with-gop-firmly-in-control/ ), I told you about the fact that a GOP Washington could mean a big change for healthcare policy. On one hand, I predicted that seismic changes may not occur for a number of reasons – 2026 election politics, Donald Trump’s desire to leave a legacy, and tight margins in each chamber of Congress. On the other hand, I said budget measures would be passed to extend tax cuts and that would have impact on healthcare and coverage.
If seismic changes to healthcare occurred, the biggest worry would be what could happen to the Affordable Care Act (ACA). As I said Monday, Trump and his VP partner, JD Vance, sought to downplay talk of ACA repeal. But they did weigh in on possible changes during the campaign. GOP Speaker Mike Johnson sought to downplay repeal talk as well, but spoke of the need for sweeping healthcare changes. Indeed, the 2017 failure to repeal and replace the ACA and the concomitant political implications are still fresh in the minds of GOP lawmakers.
Trump, Johnson, and the rightist Freedom Caucus could seek to push a repeal and replace initiative again – including getting rid of the Exchanges, rolling back Medicaid to historic levels, and devolving healthcare coverage to states via block grant schemes for Medicaid and the uninsured. But GOP members from swing districts in the House and more moderate or pragmatic senators could seek to stop the repeal.
Here is my Republican policy and political plea to the incoming Trump administration and GOP Congress as to why the ACA should be safeguarded.
The ACA is now popular among a majority of Americans
The ACA is popular with a majority of Americans in so many ways.
- Over 21 million are now enrolled in the Exchanges, with about 24 million gaining coverage in the Medicaid expansion and related programs.
- Tens of millions (as many as 100 million) more benefit from protections for pre-existing conditions. Between 150 million and 180 million benefited from other ACA protections and coverage up to age 26.
- A Kaiser Family Foundation (KFF) poll in 2024 found that Americans support the ACA 62% to 37%. About 87% of Democrats and 65% of Independents support the law. While just 33% of Republicans support it, that is still a sizeable percentage.
Red states benefit the most from Exchange coverage
Exchange enrollment tends to be greatest in red states. In part this is because many red states did not expand Medicaid. My assessment is that over three-quarters of the 2024 enrollment of 21.4 million is in red states or states that were swing states in 2024. Where red or swing states have expanded Medicaid, that would mean millions more benefited from the ACA.
The uninsured rate is down dramatically
While we still have an uninsured problem, the number of those without healthcare coverage is down dramatically since the ACA started in 2014. In 2010, there were more than 48 million uninsured Americans. In the first half of 2024, that was just above 25 million. This is about 7.6%.
THE ACA reduced costs
As a recent study in Health Affairs Forefront Blog found, the ACA has reduced, not increased, costs and that the country overall benefited from tens of millions getting reliable coverage.
The authors dissect well opponents’ positions that the ACA drove up costs and that trimmed down benefit packages are just fine. They beat down both arguments with good statistics.
GOP opponents will always point to the so-called surge in premiums for those needing individual coverage. They may be right that ACA benefits are too rich and could be reformed, but the individual market represents a small segment of overall coverage. Opponents hate the community rating that was introduced for the Exchanges. But what they don’t tell you or don’t know is that the concept is what is in place in employer coverage, which roughly half of Americans have.
Citing national healthcare expenditure data, the authors show that the ACA insurance expansions did not lead to accelerated cost growth as predicted. As the number of uninsured fell, the moving average of national healthcare expenditures (NHE) growth decreased until COVID-related spending began in 2020. The authors argue that further coverage expansion might actually drive down cost growth more. Admittedly, a lot goes into why cost increases were lower, but it does show that coverage expansion and affordable access does not lead to runaway increases.
Affordable universal access is key to future reform
In my blueprint for healthcare reform, I argue that America needs to focus on a few key tenets:
- Forging affordable universal access
- Price reform
- Pivoting from utilization management to health, wellness, prevention, and care management
But it is clear that affordable universal access is key to both of the other two tenets. Price reform and pivoting to care management will not work unless we have covered individuals that can be engaged early in their healthcare journey. In fact, it is also key to one of the core GOP demands in healthcare — personal responsibility.
Sources and additional reading
#aca #obamacare #exchanges #medicaid #healthcarereform
— Marc S. Ryan
