The Affordable Care Act (ACA), which was signed into law on March 23, 2010, has a tumultuous history.  It is a law that most Republicans and many Democrats love to hate, but upon which an ever-increasing number of Americans rely for essential health care coverage.  

The numbers are compelling: In addition to the law’s guarantee of protection for millions with pre-existing medical conditions, it expanded Medicaid to cover more than 12.5 million new people; offers meaningful protection to some 156 million American who participate in their employers’ health care programs; and has reduced the number of uninsured Americans from 48.6 million in 2010, to 28.5 million in 2018. All of those statistics reflect progress – particularly because of the importance of health care coverage to our country’s aging and increasingly unhealthy population.  

And yet, the ACA, which is also sometimes derisively called Obamacare, has some real problems.  Criticisms include the law’s financial burden on businesses, the imposition of health care coverage on younger Americans who don’t think they need it and the higher rates being charged by insurers – many of whom have no competition in large areas of coverage. And there are concerns about provisions relating to contraception without charge, required preventive care coverage and the obligation of fast-food vendors to post calorie counts, among others. Indeed, there are so many consequences and repercussions of the ACA that everyone can find something to complain about.   

We heard a lot about the ACA in the 2016 presidential campaign. The law was and remains a favorite hammering theme of then-candidate and now President Donald Trump. So it is not surprising that the president is proposing to dismantle not just problematic provisions of the law, but the entire act. What is disconcerting, however, is that he is moving forward with that effort before his administration or his party has developed a comprehensive alternative to the ACA.

Even with all of its flaws, the ACA provides real, tangible benefit to millions of Americans. The effort to uproot the entire law without a comprehensive substitute plan reflects a callousness toward the most vulnerable that is deeply troubling. Perhaps the president recognizes that his ACA court challenge could take years to resolve, and therefore thinks he has time to develop a clear plan that meets his many coverage, scope and expense promises. If so, that is cold comfort to the millions of voters who are at risk, and provides absolutely nothing for them to compare with their current plans.  

We counsel restraint. While we are not fans of all of the provisions of the ACA, we can’t help but recognize the good it has achieved. Going forward, we side with those who are taking a more measured approach and want to fix the law rather than destroy it. The millions who are currently covered under the ACA umbrella deserve that protection.  JN

 

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