What a big Republican victory on Tuesday could mean for Obamacare

While the end of the Affordable Care Act has played a role in US presidential elections for more than a decade, this race is different. Aside from a few cameos, the 14-year-old law — often referred to as Obamacare — is no longer on stage, as immigration, the economy and democracy dominate the battle between Vice President Kamala Harris and former President Donald Trump.

But 45 million Americans rely on the health law for their health coverage – either through private plans or Medicaid – and, in these final days of the race, the ACA is back in the spotlight.

At a campaign rally in Pennsylvania last week, Speaker of the House Mike Johnson told the crowd that “major reform” of the health law is needed, without specifying specifics. But he promised a “very aggressive 100-day plan” if Trump wins. “Health care reform is going to be a big part of the plan,” Johnson said.

As part of a major speech Tuesday in Washington, DC, Harris warned Americans about what could happen if the ACA is repealed. “You’re going to pay even more if Donald Trump ends up getting his way and repealing the Affordable Care Act — which would throw millions of Americans off health insurance,” Harris said, “and he took us back to the time when insurance companies had the power to deny people the conditions that existed before.

The upcoming election could have a “huge” impact on the law, says Larry Levitt, vice president of the health policy research organization KFF. Levitt has studied the ACA since its inception.

“I don’t think you can overstate the impact the ACA has had on the availability and affordability of health insurance in this country,” he says.

He recently shared details of the ACA’s record and talked about what a “big change” from Republicans would look like on a health policy podcast. Businesses.
Here are the highlights of that interview.

Discussion highlights

In the Dangers of the Affordable Care Act

If the Republicans sweep this election, I think the ACA, along with Medicaid, will have big targets on their backs. If Harris wins or the Democrats manage to hold on to one house in Congress, I think the ACA will be safe. And while the ACA has not been a major topic in this campaign, it remains a fork in the road for the future of the law.

About how the American public views the ACA

We have been voting for more than a decade and a half on the ACA. … While the ACA was being debated after it passed, there was controversy. That changed when Republicans tried to repeal and replace it in 2017. For the first time, the ACA was clearly more popular than it was and has become more popular since then. that. Currently, 62% of the public views the ACA favorably. That’s a stark contrast to when more than half of the population viewed it negatively. … Ten years have passed since the original provisions of the ACA went into effect and many people are benefiting from the law.

Why the ACA marked a ‘sea change’ in US health care

The impact was enormous. If you had a pre-existing condition before the Affordable Care Act – cancer diagnosis, multiple sclerosis, pregnancy, obesity – if you tried to buy insurance on your own, you would be denied . If it was a mild condition, you may be offered health insurance, but you may have to pay more, or have benefits related to your health condition that are not included in your coverage.

So the ACA was a sea change. Insurance companies must provide coverage regardless of your health. They will not charge you more if you are sick. And there is a list of important benefits that all insurance companies have to offer.

More than a quarter of adults under the age of 65 have a preexisting condition that would have disqualified them from insurance before the ACA. So this is not something that affects a small number of people.

About how the ACA made health insurance more affordable

Now, under the ACA, the federal government provides a tax credit that covers at least part of the premium for people with very low incomes. … It is very expensive to get health insurance in this country. I mean, health insurance for a family now costs as much as buying a car. For large quantities [who don’t have job-based insurance]without the help of the government to pay a part of the money, they would not be able to provide protection.

Why the ACA pushes the overall cost of premiums and deductibles higher

When the ACA went into effect, the price of individual health insurance went up. That’s because insurers had to provide coverage for pre-existing conditions, they had to provide certain necessary benefits – they had to cover a lot of things.

They had to cover mental health. They had to cover pregnant women. They had to cover substance abuse treatment. All of this costs money. So the premiums went up. Now, the [portion of the premium] that people pay out of their pockets went down. And that’s because of the subsidies that the federal government provides to help people pay for their health care.

On the quality of health coverage since Obamacare took effect

I think the quality of protection has gone up a lot. Benefits – the things that insurance companies have to offer – are now more comprehensive. It covers pre-existing conditions. It covers all these necessary benefits.

Currently, health insurance in general is still far from perfect. Networks — the doctors and hospitals that insurers cover — are often narrow. It can be difficult to get an appointment. That’s just not true under the ACA. This is true for people who get insurance through their employer as well. I don’t think you can add this to the ACA, but health insurance is certainly not perfect.

On Republican ideas for health care reform

There are several different theories out there. We’ve seen some of this in comments from Republican vice president JD Vance – creating high-risk pools for people with pre-existing conditions, or creating separate areas. [insurance] pools of sick and healthy people.

And looking back at President Trump’s presidency, his budgets proposed turning the Affordable Care Act and Medicaid into state aid, which means removing federal regulations and giving governments more money and giving governments flexibility in how to use that money. . We have seen similar plans, for example, from the conservative Republican group in the House that would convert Medicaid in the ACA into a subsidy to states, remove federal coverage from the insurance market, and reducing federal spending by $4.5 trillion more. ten years.

In dealing with Republican alternatives to the ACA — such as limited term health insurancehealth plan organizations and Farm Bureau life plans

All of these theories are conflicting. The ACA required mandated benefits. All of that costs money, and that is raised [monthly] premiums, especially for young and healthy people. These ideas – like dividing risk pools or health plans – are controversial on the one hand. Younger and healthier people can get cheaper insurance, but older and sicker people will end up paying more.

Tradeoffs is a health policy news organization. Dan Gorenstein is the managing editor. Reporter Ryan Levi presented this story for the Tradeoffs podcast. Deborah Franklin of Tradeoffs adapted this story for the web. You can listen to the full interview here: