House Speaker Mike Johnson (R-Louisiana) speaks as former President Donald Trump listens during a press conference at Mar-a-Lago in Palm Beach, Florida, on April 12, 2024. Mr Johnson recently promised that if he were to come to power: The Republican agenda in Congress includes “major reform” of the Affordable Care Act.
Wilfred Lee/AP
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Wilfred Lee/AP
The fate of the Affordable Care Act has influenced U.S. presidential elections for more than a decade, but this campaign is different. Aside from a few cameos, this 14-year-old law (often called Obamacare) It has almost been removed from the stage.
But 45 million Americans rely on the health care law for their health insurance through private plans or Medicaid, and the ACA is back in the spotlight in the final days of the campaign.
During a campaign stop in Pennsylvania last week, House Speaker Mike Johnson told an audience that “massive reform” of the health care law was needed, without adding details. but he promised “A very aggressive agenda for the first 100 days.” If Trump wins. “Health care reform is going to be a big part of the agenda,” Johnson said.
as part of Major speeches delivered in Washington, D.C. on Tuesday, Harris warned Americans of what will happen if the ACA is repealed. “If Donald Trump finally gets his way and repeals the Affordable Care Act, we will end up paying even more. This will leave millions of Americans without health insurance. “We will be exempt from this,” Harris said. You have a pre-existing condition. ”
He says upcoming elections could have a “huge” impact on the law. larry levitt Vice President of KFF, a nonpartisan health policy research organization. Levitt has studied the ACA since its inception.
“I don’t think it’s possible to overstate the impact the ACA has had on the availability and affordability of health insurance in this country,” he says.
he recently shared insights They examined the ACA’s performance and discussed what a “major reform” by Republicans would look like. health policy podcast trade off.
Here are some highlights from that conversation.
Interview highlights
Risks to the Affordable Care Act
If the Republicans win this election overwhelmingly, I think the ACA will have a big target along with Medicaid. If Harris wins or Democrats keep one house in Congress, I think the ACA is safe. And while the ACA has not been a major topic of discussion during this election campaign, it remains a crossroads election for the future of the law.
How Americans View the ACA
we went Opinion polls lasting more than a decade and a half About ACA. …When the ACA was being discussed after it was passed, it was quite controversial. That changed in 2017 when Republicans tried to repeal and replace it. For the first time, the ACA was clearly more popular than not, and it has grown in popularity ever since. Currently, 62% of the public views the ACA favorably. That’s dramatically different from when more than half of the population viewed it negatively. … More than a decade after the ACA’s key provisions went into effect, more and more people are reaping the benefits of the law.
On why the ACA marked a ‘major change’ in US health care
The impact was profound. If you had a pre-existing condition like a cancer diagnosis, multiple sclerosis, pregnancy, or being overweight before the Affordable Care Act was enacted, you would be denied insurance if you tried to buy it on your own. If you have a minor pre-existing condition, you may be offered health insurance, but you may have to pay higher premiums or have benefits related to your health condition excluded from your coverage.
So the ACA was a big change. Insurance companies must provide coverage regardless of your health condition. If you are sick, you cannot claim higher premiums. And there are a set of essential benefits that every insurance company must offer.
That’s all 1/4 of adults If you are under 65 and have a pre-existing condition that would result in denial of coverage before the ACA applies. So this doesn’t affect a small number of people.
How the ACA made quality health insurance more affordable
Currently, under the ACA, the federal government provides tax credits to very low-income individuals that cover at least a portion of their premiums. … the It is very expensive to buy health insurance in this country. That means health insurance for your family now costs as much as buying a car. for the majority [who don’t have job-based insurance]without federal aid to pay some of the premiums, they simply couldn’t afford the coverage.
Understanding why the ACA drove up the overall cost of premiums and deductibles.
When the ACA went into effect, prices were The price of my own health insurance has increased.. That’s because insurance companies must provide coverage for pre-existing conditions and must provide specific coverage. Mandatory Necessary Benefits – Had to Cover More Things.
They had to cover mental health. They had to cover the birth. They had to cover substance abuse treatment. It all costs money. So my insurance premium went up. Now, [portion of the premium] The idea that people pay out of their own pocket has diminished. That’s thanks to subsidies provided by the federal government to help people pay for their medical bills.
About the quality of health insurance after Obamacare takes effect
I think the quality of reporting has improved significantly. The benefits that insurance companies have to offer have become more comprehensive. It also covers existing symptoms. It covers all these necessary benefits.
Currently, health insurance in general is still far from perfect. The network of doctors and hospitals covered by insurance companies is Often quite narrow. Reservations can be difficult to obtain. Not so under the ACA. The same goes for people who have insurance through their employer. I don’t think you can apply this to the ACA, but health insurance certainly isn’t perfect.
What Republicans think about health care reform
There is have a few different ideas. Some of that was seen in comments from Republican vice presidential candidate J.D. Vance. high risk pool Create or separate facilities for people with pre-existing conditions [insurance] Pools for the sick and the healthy.
And if you look back at President Trump’s presidency, his budget proposal proposed converting both the Affordable Care Act and Medicaid into a health insurance system. Block permission This means removing federal rules and giving states a chunk of funding and flexibility in how they spend that money. For example, we’ve seen similar plans from a group of conservative Republicans in the House of Representatives that would convert the ACA’s Medicaid into block grants to states, eliminate federal protections in the insurance markets, and Cut federal spending by $4.5 trillion over 10 years.
On the tradeoffs of Republican alternatives to ACA coverage — e.g. Limited time health insuranceAssociation Health Plans, and Department of Agriculture Health Plan
All these ideas have tradeoffs. The ACA required mandated benefits. Everything costs money, and the costs were incurred [monthly] Premiums, especially for young and healthy people. These ideas, such as risk pool segregation and association health plans, have trade-offs in the other direction. Young and healthy people can get cheaper insurance, but older and sicker people end up paying more in premiums.
Tradeoffs is a nonprofit health policy news organization. Dan Gorenstein is the editor-in-chief. Produced by reporter Ryan Levi this story For the Tradeoffs podcast. Deborah Franklin from Tradeoffs adapted this story for the web. You can listen to the full interview here:
