Health care experts, consumer advocates, insurance regulators and governors from both parties have voiced concern that repeal of the Affordable Care Act would cause irreparable damage across America. Denying marketplace coverage to millions of small-business employees undergoing economic distress due to COVID-19 pandemic would be especially cruel.
What drives this desire to repeal?
The Tax Mandate
Obamacare remains a hotly debated subject. Even with Republican tweaks to the overall law, 54 percent of Americans oppose it according to Forbes Magazine.
One reason is the federal government requiring everyone to purchase health insurance; this requirement, commonly referred to as the mandate or penalty tax, was never meant as a command to buy insurance but as a penalty tax against those who do not comply.
Multiple states have challenged the mandate, alleging it to be unconstitutional without direct command from Congress. The Supreme Court will make its ruling this summer and could have far-reaching ramifications for health care in America, so potential 2024 GOP presidential candidates have chosen not to engage with this debate, fearing they could lose elections as the law relitigated. As reported by Semafor, these candidates wish to avoid revisiting 12-year old legislation for fear of losing. If the court strikes down this mandate then millions of people could lose coverage altogether and could find themselves unprotected under current plans.
The Medicaid Expansion
As its architects lacked the infrastructure, flexibility and political will necessary for its administration and implementation, much of the Affordable Care Act implementation fell upon states. This allowed state officials to manipulate or bypass laws such as work requirements or augment savings accounts while still meeting other mandates from federal or state political markets; such efforts failed on merit but kept both federal and state political markets busy with political debates over implementation strategies.
Many leaders, physicians and organizations in the medical community support Medicaid expansion due to its financial benefits for institutions; research shows it also improves economic security for low-income communities and health outcomes in long term. Stripping expansion from the Affordable Care Act during an ongoing economic crisis and deadly pandemic would be catastrophic for many families – while also further undermining an already successful public program with one of the highest coverage rates nationwide.
The Pre-Existing Condition Clause
Before the Affordable Care Act (ACA), insurers could deny coverage to people with preexisting conditions and charge them higher premiums. Now, thanks to this landmark legislation, these practices have been prohibited and over 100 million Americans are protected against them – an effect which Republican repeal proposals seek to take away.
Repeal would deny millions of young adults access to affordable health insurance coverage. Under the Affordable Care Act (ACA), young adults have been allowed to remain on their parents’ coverage until age 26; this has drastically decreased uninsurance rates among this demographic by half while simultaneously eliminating racial gaps in coverage across states that adopted it and cutting marketplace premiums by an average of 40 percent for those with lower incomes.
The Trump administration has engaged in an aggressive effort to undermine the Affordable Care Act. Their tactics have exceeded administrative discretion and challenged our constitutional system; yet its demise remains at bay; Congress must present a full and detailed replacement bill for consideration by American people.
The Insurance Exchanges
Exchanges are the sole place where individuals can purchase health coverage that conforms to Affordable Care Act requirements and qualify for premium tax credit subsidies, while also playing an instrumental role in defining its essential health benefits (EHBs). Since President Donald Trump took office, regulatory countermoves have been deployed against the ACA including cutting off taxpayer funding flows to insurers as well as loosening interpretation of statutory guardrails on state individual market waiver proposals more loosely than Obama-era officials had done previously.
The Republican repeal plan may do away with both ACA insurance markets and exchanges as well as its requirements that individuals purchase coverage or face penalties, further exacerbating market trends such as struggling small-group markets with rising premiums, rising insurer participation levels, preexisting condition protections being rendered unenforceable, as well as federally administered risk stabilization programs designed to control premium increases for consumers.