By George W. Chapman
Two Republican presidential candidates — so far Trump and DeSantis — are, for some inexplicable reason, pledging to get rid of the ACA, often referred to as “Obamacare.”
Trump calls Obamacare a “disaster” and “terrible healthcare.”
There have already been more than 40 exhausting, politically motivated attempts to repeal the widely popular ACA.
So this begs the question, who is lobbying and pressuring the presidential candidates to get rid of this “disastrous” program?
Interestingly, neither candidate refers to the historical health insurance act as the “Affordable Care Act” because they are deliberately politicizing and confusing the issue by referring to it as “Obamacare.”
They won’t call it the “ACA” because it is widely popular, in both red and blue states, especially for those who are covered by it.
By calling it “Obamacare” they are hoping to dredge up some lingering antipathy toward the former president and grab some misinformed votes. Past surveys have confirmed the confusion. When asked should “Obamacare” be repealed, many people’s knee jerk response was “yes.” But when asked if the “Affordable Care Act” should be repealed, the same people thoughtfully answered “no.”
The ACA has been law for 13 years and has grown in popularity every year. As of the end of 2023, 40 million people are covered by the ACA either by qualifying for expanded Medicaid or qualifying for discounted premiums based on household income.
The ACA has decreased the percentage of us without health insurance from around 15% to around 8%.
I can’t imagine it’s the very people that rely on the ACA for coverage that are trying to get rid of it.
Maybe it’s the insurers?
The ACA is administered by some of the same commercial carriers that cover those fortunate enough to be covered by employer-sponsored health insurance, mostly paid for by employers.
Granted, commercial carriers have opted in and out of the ACA market every year, but insurance companies do that in all their markets. It’s not just the ACA. Carriers are prone to exit a particular market because of low enrollment or low profitability. Most states have around five carriers involved in the ACA. I don’t think insurers are too upset with the ACA.
Maybe it’s the providers. Hospitals, physicians and nurses must be behind the idea of nixing the ACA. And to show their utter dissatisfaction, they single out their patients covered by the ACA and provide them with “terrible” sub par healthcare. When someone claims the ACA provides “terrible healthcare” they are insulting every hard-working physician, nurse and hospital in the country. (Insurers, like the ACA, pay for care; they don’t provide care.) Fact is, I have not heard or read that any of the various medical associations (AMA, AHA, ANA, etc.) expressing their displeasure on behalf of their members with the ACA, per se.
If there is any displeasure among providers, it is with all payers. So, you can’t single out the ACA.
Thanks to the ACA, hospitals and physicians worry far less about uninsured patients (less than 8%) unable to pay for their care. (Early critics and naysayers of the ACA, back when it was first being proposed, predicted it would create pure hell — vandals at the gates — for providers because their offices, ERs and operating rooms would be flooded with people with years of pent-up medical problems, Never happened.)
Without the ACA, more hospitals, especially rural ones, would have eventually closed under the weight of unreimbursed care. The ACA is popular in both red and blues states with the former probably having more rural hospitals.
The ACA also made deciphering dozens of insurance plans and making valid comparisons, far easier. (Just ask anyone in human resources.)
The ACA created three levels of insurance with increasing amounts of mandated coverage: bronze, silver and platinum. Most employees are covered by a medium priced “silver” level.
An individual who purchases health insurance on the exchange would have the same three coverage options. When considering either BlueCross silver or Aetna silver for example, it is apples to apples. Of course, insurers can “spice up” their plans to attract more members, but they must include the minimum mandated benefits for the level.
Most importantly and now taken for granted, the ACA finally ended the infamous pre-existing condition clause in insurance contracts that basically prevented anyone with a “pre-existing condition” from switching plans because any new plan would refuse to cover the condition.
Pre-existing conditions could include cancer, AIDS, pregnancy, cardiac disease or even hypertension.
Pre-existing conditions virtually locked employees into their place of employment. Some people would have to refuse a better job offer at another employer for fear of losing coverage if the new employer offered different insurance.
So, I cannot fathom which of the four major stakeholders in the ACA (insurers, hospitals, physicians, patients) are pressuring the two presidential candidates to get rid of the “terrible healthcare” paid for by “Obamacare.”
Surveys show there are far bigger challenges on voters’ minds like immigration, climate change, inflation, national security, voter rights and reproductive rights to name a few. Surveys do indicate however that voters are dissatisfied with the expense of healthcare in our country and rightly so.
If you want to campaign on healthcare, our entire system needs a fix. Just don’t single out the ACA as the problem.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.