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Wait a Minute! Do We Really Want to Repeal and Replace the ACA?

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Suzanne Discenza
February 21, 2017

This article is second in a series of six monthly columns exploring the future of current government-sponsored healthcare policies and programs.

Although many health policy analysts had predicted the inauguration of President Donald Trump, coupled with a Republican-controlled Congress, would signal the quick demise of the Affordable Care Act (ACA), the first month of the new administration has come and gone without appreciable progress toward that end. Instead, there appears to be a new awareness by the President, his advisors and a growing number of Congressional representatives that many of their constituents may wish to preserve, and even expand, many of the act’s protective and/or economically advantageous (to some industry players) provisions.

For example, an article in the February 16, 2017 issue of the Wall Street Journal claims a new Trump administration proposal to bolster health insurance exchanges through offering more incentives to insurers “is a sharp reversal from the days after the election when President Donald Trump and Republicans vowed to rapidly strike down the law.” The authors further reminded their readership of a recent statement by the President suggesting, “an ACA replacement may not be completed until next year.”

Members of the United States Senate and House of Representatives have been feeling the heat, with Republicans across the country trying to balance 2016 campaign promises to repeal Obamacare on the one hand, while on the other trying to deal with angry constituents in their home districts who fear they may lose their health insurance coverage either partially or entirely with elimination of many provisions in the ACA. Jesse Paul, in a January 24, 2017, article in The Denver Post, reported on the dramatic uptick in Colorado of citizen contacts to their Congressmen and protests involving the ACA. U.S. Rep. Mike Coffman (R-Aurora) received national attention after many citizens became upset when he left his own Town Hall meeting early before they could talk to him about an opinion piece he co-authored in The Post about why he would vote to repeal the ACA. In the same article, U.S. Rep. Diana DeGette (D-Denver) was quoted as saying “her constituents have been worried mainly about health care, speaking out in a chorus of Facebook interactions, calls and notes three times higher than she normally sees,” including 1500 emails on Obamacare alone.

While some Congressional representatives have steadfastly stood by their pledges to repeal the ACA in its entirety, others on both sides of the aisle are promising to preserve some of its provisions, including protecting health services for those with pre-existing conditions. Additionally, governors, legislatures and media outlets in many states standing to lose the most should the ACA be repealed have come out strongly in defense of retaining major provisions in the law. For example, over the past month news outlets from National Public Radio to Bloomberg.com have reported on the growing number of governors from both parties, including up to 12 Republican governors, who have warned Congress against the repeal of the ACA due to the negative economic impacts on their states.

Discenza

Perhaps individual state examples tell the story most clearly. According to the U.S. Census Bureau, the number of uninsured individuals in the state of West Virginia fell by 38.8% between 2013 and 2014, from 14% of the population to 8.6% of the population, primarily due to the state’s adoption of Medicaid expansion and enrollment in the state’s new health insurance exchange. However, following threats of imminent repeal of the ACA, West Virginia’s Register-Herald published an in-depth article on January 26, 2017, detailing the negative consequences repealing the law would have on the state. These included not only impacts on healthcare services for minorities, women and low-income individuals, but 184,000 state residents would lose their health insurance entirely.

The article went on to report the adverse impacts on West Virginia’s economy:

“An estimated 16,000 jobs would be lost by 2019 and nearly $350 million would be lost in tax revenue over five years. The Urban Institute estimates West Virginia would lose $14 billion in federal funds between 2019-2028, including $12 billion supporting Medicaid/CHIP.”

Despite early predictions to the contrary, all eyes in health policy circles remain on the yet-to-be-determined fate of the ACA after the first month in the new Presidential administration. As the larger implications of its repeal have emerged, repeal or replacement of the law has become increasingly problematic. Part III of this series will take a closer look at what individual state and local legislative bodies are doing to ensure (or not) healthcare services for their citizens in the face of national uncertainty.


Author: Suzanne Discenza currently serves as a lecturer in the School of Public Affairs at the University of Colorado Denver and as an adjunct professor in Public Administration and Healthcare Management at Park University.  Former Director of the MHA Program at Park, she also serves on the ASPA National Council and as Past Chair of the Health Policy Forum of AUPHA.

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The American Society for Public Administration is the largest and most prominent professional association for public administration. It is dedicated to advancing the art, science, teaching and practice of public and non-profit administration.

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