Undermining the Affordable Care Act

What’s the issue? Despite several attempts over the course of the summer and fall, Republicans failed to repeal the Affordable Care Act (ACA) and/or replace it with their own approach to health care. I wrote about the House and the Senate’s (several) attempts to pass their own legislation and their flaws. The Republicans never meaningfully engaged the Democrats on this issue, and tried only to pass legislation using the Republican majority in the House and Senate. However, the bills failed to pass because they failed to get enough Republican support. Polls also showed that over 50% of Americans support the ACA.

Why do I care? Although the Republicans failed to repeal and replace the ACA and have moved on to tax reform, they have been waging a quiet campaign to undermine the ACA since the day it was signed into law. These attacks have been increasing, and have already reeked havoc on the law. Unchecked, they could lead to just the sort of “death spiral” for the ACA that the Republicans have long been hoping for. Below are some of the ways Republicans have been undermining the ACA:

• Legal challenges– Republicans began to challenge the ACA in courts the day that it was signed into law. They challenged the constitutionality of the individual mandate, which requires everyone to have health insurance and means that enough healthy people sign up for insurance to offset the expenses of the sick and keep the insurance system profitable over time. The Supreme Court ruled that the individual mandate was constitutional, but also said that the government could not withhold Medicaid funding from states who refused the Medicaid expansion offered under the law. As a result, 19 Republican-led states refused to expand Medicaid, which in turn caused insurance companies to raise premiums in those states. Republicans then pointed to these increases as evidence that the law was failing.
• Uncertainty for insurance companies– In another legal challenge, Republicans challenged the constitutionality of “cost-share reductions,” which make insurance payments affordable for Americans making less than 250% of the federal poverty line. A judge ruled in their favor, but allowed the payments to continue while the ruling was appealed. Trump has the power to unilaterally drop the case and stop the payments, which he has threatened to do. This threat has had a destabilizing effect on insurance markets, forcing some companies to raise premiums or withdraw from the markets all together. Meanwhile, in 2014, the Republican-controlled House also sharply reduced payments promised by the government to insurance companies to help offset some of the risk of participating in the new marketplace. The reneging of this promise by the government caused many insurance companies to go out of business and disrupted health coverage for at least 700,000 Americans.
• Lack of promotion/marketing– The Trump administration has halved the open enrollment period for the ACA, reducing the time it is possible to enroll from November 1st, 2016- January 31st, 2017 to November 1st- December 15th, 2017. Additionally, the Trump administration severely cut promotion and advertising funding for the ACA enrollment period (reducing funds by 90%), and failed to renew the contracts for “in-person assisters”, meant to provide in-person support for Americans signing up for insurance in 18 cities, making it harder for Americans to shop for health coverage. Even the anticipation of these changes may have contributed to the decrease in ACA enrollment for 2017, which the Brookings Institution found was not caused by premium increases, as Republicans claimed.
• Individual mandate– This week, Trump has urged Republicans to repeal the ACA’s individual mandate as part of their tax reform bill. Nonpartisan analysis suggests getting rid of the individual mandate would leave 15 million Americans without health insurance. Although many Republicans realize that this would be a risky move that could imperil the success of the tax legislation, Trump is pushing hard for it, and the House Ways and Means Committee Chairman has begun the first steps to have it considered for inclusion in the bill.

Trump has made no secret of what he and his fellow Republicans hope to accomplish by undermining the ACA. As he tweeted in July, “As I said from the beginning, let ObamaCare implode, then deal. Watch!” Although they haven’t been as forthcoming about their strategy, the Republicans have been following the same playbook for years before Trump was elected. They hope that when they hinder the ACA enough to make it fail, voters will blame the Democrats and law itself, instead of the Republican sabotage. We have to make sure that doesn’t happen.

What you can do if you care too:

1. Call your Congresspeople. Make it clear that repealing the individual mandate as part of tax reform is unacceptable. While you’re on the phone, you can give your opinion on the tax reform legislation as well.
2. Donate to Get America Covered, an independent campaign to help raise awareness about ACA open enrollment and the new deadlines.
3. Raise awareness about Open Enrollment. Get America Covered has a social media kit that you can use to spread the word about ACA open enrollment on your own social media platforms. If you’re feeling more motivated, you can join a street team to talk to people in your community and distribute information about open enrollment.
4. Challenge the assertion that the ACA is failing under its own weight. If you hear people making this claim, remind them of all the ways the Republicans are sabotaging the law (you can use the references I’ve hyperlinked to in this blog). Write letters to the editor or op-eds reminding people of this as well.