Here they go again. Once more, Senate Republicans are trying to dismantle the Affordable Care Act. This renewed assault is a shameful exploitation of Sen. John McCainJohn Sidney McCainWhat we can learn from Bob Dole Biden nominates Meg Whitman as ambassador to Kenya Dole to lie in state in Capitol Rotunda MORE’s (R-Ariz.) death. While praising his character, commitment to duty and faithfulness to the rules of democratic governance in public, privately Republicans are using the same tricks McCain rejected as inconsistent with regular order and deliberative democracy to ram through a wildly unpopular repeal of the ACA.
Senate Republicans’ new attempts to defund a system that has lowered healthcare costs and expanded coverage for millions of Americans is bad policy, bad politics and an undemocratic assault on representative government.
But right after the 2016 election, Republican began to undermine the law and destabilize the insurance exchanges. As a result, the uninsured rate rose for the first time in several years in 2017 and 2018 and insurance premiums on the exchanges spiked.
One of the great achievements of the ACA was to convert Medicaid from a categorical program — available largely to children, pregnant women, the poor elderly and disabled — into a program open to all Americans earning under 138 percent of the federal poverty line (roughly $34,600 for a family of 4).
In the 34 states (including the District of Columbia) that expanded Medicaid, about 15 million Americans gained coverage. The push to add work requirements to Medicaid eligibility in many states will slash enrollment by between 1.4 to 4.0 million. This is a sad reversal of a good policy.
Republicans haven’t just tried to throw people off Medicaid, they have sabotaged the health insurance exchanges and increase insurance premiums. They halted risk-adjusted payments to insurers. They stopped paying cost-sharing subsidies.
They repealed the individual mandate. And they shortened the open enrollment period and slashed budgets for marketing and navigators who support the exchanges. These capricious decisions created significant uncertainty for insurers which, in turn, increased premiums by double digits.
Amazingly, the Trump administration and Republicans have given up on a replacement plan. Eight years after the passage of the ACA, they no longer even feign having a viable alternative.
In less than two years, the Republicans have been “successful” in achieving the twin goals of increasing the uninsured rate and increasing health insurance premiums. Every rational person realizes this is bad policy with no positive outcomes.
But the Republican approach to health care is also self-destructive politics. The assault on the ACA has increased American support for the law. According to the Kaiser Family Foundation, 76 percent of Americans support keeping protections for pre-existing conditions and 65 percent of voters ‚ including 43 percent of Republicans — say that a candidate’s position on continuing protections for people with pre-existing health conditions is one the most important factors in winning their vote.
Moreover, over half of people living in states that have not expanded Medicaid are in favor of expansion. Most recently, a petition in the deep red state of Nebraska to put the Medicaid expansion on the ballot garnered over 100,000 signatures, putting the issue on the November 2018 ballot. Even after the repeal of the individual mandate, 84 percent of people who purchased individual insurance on the exchanges want to keep their plan. The ACA has only become more popular with voters since its enactment.
While repeal of the ACA may be meant to activate the Republican base, that repeal constituency is vanishing. The American Health Care Act, Republican’s so-called replacement, received middling support even from Trump voters and this year there is very little support for repeal.
This latest attack on the ACA reveals Republicans’ complete lack of democratic values. Barely a year ago, an elected Congress rejected two attempts to repeal the ACA. Now, Senate leaders want to try again, after McCain’s swing vote is replaced by an unelected, caretaker Senator. This is a total subversion of the democratic process. The American people have spoken and they do not want repeal.
Given all the Republicans are doing to undermine the ACA, one wonders whether they are secret supporters of single payer. Republican sabotage has only accelerated support for a single-payer approach. Recent polls indicate that that 59 percent of Americans support “Medicare for all.”
That number includes 36 percent of Republicans, who appear to be frustrated with their party’s determination to demolish the ACA. The Republican Party should tread lightly on health care reform; the more they insist on dismantling a working system that created a market of competing private insurers to provide universal coverage, the more voters will demand a single payer system to once and for all.
Ezekiel J. Emanuel is chair of the department of medical ethics and health policy at the University of Pennsylvania and a senior fellow at the Center for American Progress. Until January 2011, he served as a special advisor on Health Policy to the Director of the Office of Management and Budget and National Economic Council. Sarah DiMagno is a senior research fellow to Dr. Emanuel. She holds a B.A. in Economics & Political Science from Yale University. Aaron Glickman is a senior research fellow to Dr. Emanuel and a policy research analyst at the University of Pennsylvania. He holds a B.A. in Government from Cornell University.