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 Hide caption
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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, immigration, the economy, and democracy dominate the fight between Vice President Kamala Harris and former President Donald Trump, as this 14-year-old law (often referred to as Obamacare) ) has mostly been done behind the scenes.
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 Trump promised a “very aggressive agenda for the first 100 days” if he wins. “Health care reform is going to be a big part of the agenda,” Johnson said.
As part of a major speech in Washington, D.C., on Tuesday, Harris warned Americans about what could happen if the ACA is repealed.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. ”
Larry Levitt, executive vice president of KFF, a nonpartisan health policy research group, said upcoming elections could have a “huge” impact on the law. 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 insight on the ACA's track record and discussed what “big reform” by Republicans would look like on the health policy podcast “Tradeoffs.”
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've been polling on the ACA for more than a decade and a half. …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.
More than a quarter of adults under age 65 have pre-existing conditions that would have led to denial of coverage before the ACA. 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. …It is very expensive to get health insurance in this country. That means health insurance for your family now costs as much as buying a car. For the vast majority (those without employment-based insurance), they cannot afford it without federal assistance to pay a portion of their premiums.
Why the ACA drove up the overall cost of premiums and deductibles
When the ACA went into effect, the price of self-purchased health insurance increased. That's because insurance companies needed to provide coverage for pre-existing conditions, provide certain essential benefits, and cover more.
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, the premiums people pay out of pocket (part of the insurance premium) have gone down. 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. Insurance companies often have a very narrow network of doctors and hospitals covered. 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.
About the Republican Party's health care reform plan
I have a few different ideas. Some of this was seen in comments by Republican Vice Presidential candidate J.D. Vance, who called for creating high-risk pools for people with pre-existing conditions, or separate (insurance) pools for people who are sick and people who are healthy. It's about building a pool.
And if we look back at President Trump's term, his budget proposed converting both the Affordable Care Act and Medicaid into block grants to states. This means removing federal rules and giving states a chunk of funding and flexibility in how they use that money. . For example, a similar plan has been floated by 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 increase federal spending by $4.5 trillion. The idea is to reduce it. 10 years.
On the trade-offs of Republican alternatives to ACA coverage, including limited-time health insurance, association health insurance, and Farm Bureau health insurance.
All these ideas have tradeoffs. The ACA required mandated benefits. It all costs money and has increased (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. Reporter Ryan Levi created this story for the Tradeoffs Podcast. Deborah Franklin from Tradeoffs adapted this story for the web. You can listen to the full interview here:
