Repeal Obamacare? Really?
Repeal of the Affordable Care Act, also known as Obamacare, is a well-known priority of President-elect Trump and Republicans in Congress, bolstered by Trump voters.
But, while “yes or no” polling about the possible repeal of the ACA tells us something about Republicans’ antipathy to the law, more detailed polling questions reveal a complex picture.
A Kaiser Health Tracking poll in November reveals that, as expected, half of Trump voters would like to repeal the entire ACA and 29 percent would like to scale it back (compared with 26 percent of all Americans for repeal, 17 percent for scaling back, and 30 percent in favor of expansion).
However, when respondents were asked about individual provisions of the law, a different picture emerged.
Of Republicans, 82 percent have favorable opinions of allowing young adults to stay on their parents’ plans till age 26, 77 percent approve the free provision of preventive services, and 69 percent like closing the Medicare “doughnut hole” that decreases the cost of drugs. Similarly, 72 percent of Republicans like the health insurance exchanges, 67 percent approve of the insurance subsidies, 67 percent approve of Medicaid expansion, 63 percent approve of preventing denial of insurance for pre-existing conditions, and 63 percent approve of increasing the Medicare payroll tax for upper-income Americans.
The only two provisions that did not get favorable ratings from Republicans are the mandates: only 45 percent supported requiring employers to pay a fine for not providing health insurance and only 21 percent supported fining individuals who don’t get health insurance.
Notably the GOP respondents were in favor of the benefits, but not the law’s mechanisms for funding the benefits.
These findings should give the repealers pause.
In addition, a recent Urban Institute brief on the effect of partially repealing the ACA through the “reconciliation process” should also give the repealers pause. If this process is used, the budget provisions, such as the subsidies and the Medicaid expansion, could be repealed, but other provisions, such as guaranteed coverage to those with pre-existing conditions and essential health benefit coverage, could not.
The report’s authors estimate that the number of uninsured would rise by about 30 million. And, of these, 56 percent would be non-Hispanic whites and 80 percent of the adults would lack college degrees. These demographic sectors are well-known to be Trump supporters and are unlikely to be pleased at finding themselves uninsured.
The displeasure at losing health insurance would be exacerbated by skyrocketing premiums, thanks to the maintenance of the ACA’s benefits, which can’t be eliminated through reconciliation, combined with the cuts in their funding.
So, Republicans, take heed! One of the principal precepts of medical ethics is “First, do not harm.” If you don’t want to alienate your base in the first days of this administration, don’t mess with their health coverage. Instead, work on a bipartisan solution to protect and expand coverage for all.
Jessica Schorr Saxe, MD, is chair of Health Care Justice – NC. Contact her at HCJusticeNC@gmail.com