The latest information on the success of the Affordable Care Act is a further reminder of what is at stake on Election Day. Voters should cast a wary eye on the vague "repeal and replace" slogans offered by Republican presidential and congressional candidates.
Statistics released last week revealed that even though there has been little or no growth in health insurance coverage in recent years among Americans covered by employers, there has been a dramatic growth in the number of Americans who have gained health insurance coverage. The difference is the coverage provided by the ACA, with the expansion of Medicaid that came under President Obama's law fueling the growth to a large extent.
The Census Bureau's Current Population Survey found that while the number of people covered by employers in 2013 and 2014 did not change in a statistically significant way, the total number of uninsured people dropped by 9 million. This occurred during a major expansion of the law's coverage. Going back to 2010, the National Health Interview Survey reported that while insurance coverage by employers was stagnant between that year and 2014, 12.6 million more Americans gained health insurance. In sum, the ACA, its flaws aside, and accomplishing its goal of providing Americans and their families with health insurance.
This poses a real problem for Republicans, whose doctrine requires sworn opposition to "Obamacare" regardless of facts, statistics, and grateful Americans. "Repealing the law without a plausible plan for replacing it would be a mistake," warned a policy paper from 10 Republican health policy experts published in the conservative American Enterprise Institute.
There is no sign of a plan — at least plausible one. Likely Republican presidential nominee Donald Trump, who wouldn't go beyond promising a "terrific plan" to replace the ACA in the debates, this month offered a bare-bones plan largely based on failed Republican ideological dogma.
In recent weeks, Mr. Trump has gone beyond promising a "really terrific" health plan to offering a few specifics. Fiscalfactcheck.org observes that repealing the ACA, as Mr. Trump has promised, would cause about 21 million people to lose health insurance, while Mr. Trump's bare-bones plan would only cover about 5 percent of those who lost coverage. It estimates that his proposal to create a tax deduction so Americans can buy their own health insurance would cost a budget-busting $70 billion over 10 years.
Senator Ted Cruz's plan, which like Mr. Trump's is based largely on Republican dogma, calls for a nationwide health care marketplace for insurance, but doesn't account for the immense pricing difference between heavily populated and sparsely populated states. His plan also calls for expanded use of health savings accounts allowing tax-free withdrawals, but in practice those tax breaks are largely eaten up by high deductibles and maintenance and transaction fees. Notable by its absence in both the Trump and Cruz plans is guaranteed protection for those with pre-existing conditions against being denied coverage by insurers, a key component of the ACA that is popular with Americans.
The plan has flaws, which is not surprising given its complexity. Consumers have had trouble navigating through to find the right policy and it can leave patients open to crushing medical bills. The latter, of course, is a system-wide problem in our health care system, where costs are rising and insurers aren't willing to sacrifice from their profit margins.
Shortcomings aside, the ACA has done what it was charged to do — get millions of Americans health care insurance. The "repeal" promised — or threatened — by Washington Republicans and presidential candidates is a terrible idea, especially given that the "replace" part of the GOP mantra is either nonexistent or unworkable.