Guest opinion: Don’t repeal ACA without a replacement
December 28, 2016
Though it's clear that not everyone likes the Affordable Care Act (ACA, or Obamacare), recent surveys show that key parts of the law are popular with a vast majority of Americans regardless of political affiliation. And a closer look at how Colorado communities have fared in the last several years suggests that residents have reaped some clear benefits.
Indeed, a Kaiser Health Tracking Poll conducted after the election shows at least 75 percent of respondents support the ability to get free preventive care with their health plan. The survey showed at least 83 percent like a requirement that allows recipients to keep their kids on their plans until age 26. Meanwhile, at least 68 percent like the availability of financial help to purchase coverage.
It is also worth noting that since the ACA went into effect, millions of Americans have been able to access health insurance coverage — and hence, quality health care — for the first time.
Regardless of these positive benefits, ACA has encountered a backlash among some consumers because of high premiums, high out-of-pocket costs and narrow provider networks in currently available plans. Many of those concerning trends are symptomatic of problems long associated with the health-care sector rather than ACA itself. Nevertheless, on Election Day, a significant number of voters signaled they wanted America to change the way it does business. As a result, the president-elect and congressional leaders are poised to repeal the ACA.
Of course, the ACA has flaws that became apparent as it was implemented and that should be addressed. Unfortunately, many in Washington seem intent to throw out the health-care baby with the ACA bathwater. Among the proposals being discussed:
• Sweeping cuts in the federal Medicaid program that provides coverage for individuals and families. An anticipated two-step process would begin with defunding the Medicaid expansion, and would then expand to broader program cuts, ultimately reducing the federal contribution to Medicaid by $1.5 trillion over 10 years. Though critics have characterized the Medicaid program as too expensive, Medicaid enrollees cost the system significantly less than similar enrollees in the private sector. In Colorado, the Medicaid expansion has provided coverage to more than 350,000 residents whose improved access to health-care facilitates work and strengthens families.
• Though no specific "replacement plan" for the ACA has been discussed, congressional leaders have floated a number of private-market remedies that won't help millions of people keep their coverage or make health coverage any more affordable. For example, many leaders favor expanding the use of "health savings plans" or HSAs. While sound in theory, HSAs help consumers only if they have the luxury of setting cash aside each month.
Many Americans simply lack the income to make such a savings commitment. Another potential change, giving carriers the right to sell plans across state lines, wouldn't provide Coloradans with more affordable coverage. Because carriers could base plans outside of Colorado, Colorado regulators would be unable to enforce state-legislated consumer protections. The National Association of Insurance Commissioners predicted that such a change would reduce the availability of insurance. Even the conservative Heritage Foundation expressed doubts that the approach would reduce prices.
Without a clear plan to replace the ACA with something that allows recipients to maintain coverage, repeal would potentially revoke health-care coverage for millions of American citizens and hundreds of thousands of Coloradans. The effects of repealing the ACA would be apparent locally. For example, Colorado's decision to expand Medicaid got 4,261 adults in Garfield County enrolled, and they were able to access treatment and services ranging from mammograms to substance use disorder treatment to immunizations. Local hospitals also benefit from reductions in the amount of uncompensated care they must provide.
The Western Slope's congressman, Scott Tipton, claims that getting rid of the ACA will "restore control over health-care decisions back into the hands of individuals, families and their doctors." Obviously, that won't happen unless we know how Coloradans will maintain equal or better coverage.
Before repealing the law or taking away the funding Coloradans rely on, the Colorado delegation should make sure that a new, better plan is in place.
Bethany Pray is a health care attorney with the Colorado Center on Law and Policy.