The Obama administration announced this week that 11.4 million people signed up for health coverage during the most recent enrollment period, making it ever harder for critics who love to hate the Affordable Care Act (ACA) to hate it. Despite its success, the threats against the ACA loom large, both in the form of the upcoming Supreme Court case challenging the subsidies that have made coverage affordable for so many Americans, and also in the recent healthcare proposal released by Senate Republicans. Both would be a significant step back for low-income families.
Last week, Sylvia BurwellSylvia Mary Mathews BurwellThe biggest revelations from Fauci's inbox What a Biden administration should look like Bogeymen of the far left deserve a place in any Biden administration MORE, secretary of Health and Human Services, warned that the majority of the 8.6 million individuals who now have coverage through the exchanges would be negatively impacted should the Supreme Court determine that individuals living in states without their own health exchanges cannot receive subsidies. Such a decision would be devastating for millions of newly insured and also for the law more broadly, and it would pave the way for a new, and far less comprehensive, health plan.
Republican Sens. Richard BurrRichard Mauze BurrEmboldened Trump takes aim at GOP foes NC Republican primary key test of Trump's sway The 19 GOP senators who voted for the T infrastructure bill MORE (N.C.) and Orrin HatchOrrin Grant HatchCongress, stop holding 'Dreamers' hostage Drug prices are declining amid inflation fears The national action imperative to achieve 30 by 30 MORE (Utah) and Rep. Fred UptonFrederick (Fred) Stephen UptonKinzinger says Trump 'winning' because so many Republicans 'have remained silent' Emboldened Trump takes aim at GOP foes McCarthy-allied fundraising group helps Republicans who voted to impeach Trump MORE (Mich.) recently released one such plan that they hope to build upon the ashes of ACA, which they and their conservative colleagues have tried mightily to burn to the ground. Their proposal — the Patient Choice, Affordability, Responsibility and Empowerment Act, or the Patient CARE Act (PCA) — raises more questions than it answers, but it is clear that the plan would be a step backwards for many low-income U.S. families that have benefitted from the ACA.
Republicans would like for us to think that the ACA has been a dismal failure that has done more harm than good. And it would be fair if you believed that, given the more than 50 times they have voted to repeal the law and their relentless efforts to thwart some of the its most significant provisions. Is it really possible for something that is actually helping people to stoke such intense hatred? Indeed, it is.
The ACA is far from perfect. But it is a significant improvement over the tearing-at-the-seams patchwork quilt that predated it. How quickly we forget that before the ACA, people were routinely denied insurance based on preexisting conditions (like having given birth). Women were charged higher premiums than men just because they were women. Individuals with insurance often didn't seek out preventive care because of high co-pays. Uninsured young people wished away illnesses because they couldn't afford the out-of-pocket cost of visiting a doctor. And lots of women didn't use birth control because they simply couldn't afford it. The ACA solved these problems for millions of people.
Sure, the website was a disaster at the outset. And some people have had to get new plans (mostly because their old plans offered inadequate coverage and carried higher out-of-pocket expenses). And navigating the enrollment process was no walk in the park. And, of course, lots of people are still not covered (thanks, in large part, to conservative lawmakers who refuse to participate in Medicaid expansion). Indeed, coverage could be even more comprehensive. But by many measures the ACA has been a success, and we should be building on that, not diminishing it.
What would the PCA mean for everyone who has gained insurance? Well, from starting gate, they would likely need to find new coverage because it would repeal the ACA in its entirety. In doing so, it would eliminate Medicaid expansion, the health exchanges, tax credits and the ACA's cost-sharing reductions.
According to the Center for Budget and Policy Priorities — which evaluated the first iteration of this plan in May — that's just the beginning. Under the PCA, a number of individuals who currently enjoy premium tax credits under the ACA would no longer qualify, including legal immigrants and people with incomes above 300 percent of the federal poverty level (currently individuals with incomes up to 400 percent qualify for tax credits). The older among us could be charged five times as much — or more — than younger people, and their tax credits would be much lower. There are fewer protections for customers with preexisting conditions and patients would likely pay more for deductibles and co-payments. Insurance plans would likely not be required to include the comprehensive host of benefits guaranteed by the ACA.
The plan would likely leave states with inadequate funding for Medicaid, forcing them to increase their own spending or make cutbacks to programs that low-income families rely on. Insurance companies could set annual coverage limits, could lift caps on out-of-pocket expenses and could charge women more than men. States would have the freedom to determine whether or not young people under 26 can get coverage through their parents' health policies. The new plan would be a rollback, not progress.
In the coming weeks, conservatives will continue to bear down on the ACA, highlighting its failures — both real and contrived — over its successes and trying to convince the American public that we would be better off without it. If they have their way, it will upend a system that is now working for millions and we might very well find ourselves longing for the days of website glitches.
Flynn is a fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn.