Just a quick refresher on the ACA animosity in the Republican Party

Our friend Scottie asked me why the Republican Party detests the Affordable Care Act (ACA) so much and wants to kill it. I have written many posts about this, but here is quick refresher.

The Republican party has spent about ten years nay-saying the ACA. This is in addition to actual efforts to sabotage it by Senator Marco Rubio and President Donald Trump and the fourteen states who still have not expanded Medicaid. Rubio and Trump’s actions caused premiums to increase. Blue Cross and Blue Shield of North Carolina (BCBS of NC) said it was geared to have a 0% increase in 2018, but after Trump de-funded reimbursing insurers for co-pays/ deductibles for people making less than 2 1/2 times the poverty rate, BCBS of NC said it would have a 6.6% increase. Not only did Rubio’s action cause premiums to go up, it drove some insurers out of the exchanges lessening competition which also hurt consumers. *

So, to me the Republicans are so far down the path of killing something that is working pretty good (it still needs improvements), they cannot stop. And, it is apparent that Trump has an Obama obsession that he must kill everything that Obama did regardless of its level of efficacy. As a retired benefits consultant and former actuary, what the GOP came up with in 2017 to replace the ACA was god-awful. It was throw-against-the-wall planning. The fact the Republicans did not follow due process was a key reason Senator John McCain voted it down. Mind you, I fault Obama for the terrible roll out of the exchanges in 2013, but he at least involved Republicans in the planning process in very public sessions (although they were told not to vote for it).

And, here is the rub. The reason the GOP does not have a plan is the ACA is largely based on a Republican idea set in motion by Mitt Romney for Massachusetts, when he was governor. It worked so well, that Senator Jim DeMint, the leader of the Tea Party, advocated its national use in writing to President George W. Bush. And, DeMint politicked with Romney on stage in 2008, Romney’s first run for president. I recognize the ACA is not exactly the same as Romneycare, but there are a number of similar constructs.

Everything I mention above, including the DeMint piece can be found by Googling. But, here is the major concern I have. Employers have been going to more part-time and contract work forces even before the pandemic. Why? – to avoid providing subsidized health care benefits. So, to survive in this gig and part-time employment world, the ACA is essential.

Plus, the ACA imposes requirements on employer based plans as well that may go away if SCOTUS rules unwisely with the court case. Those include pre-existing condition protection, guaranteed renewability, no deductibles on wellness visits, and limitations on insurer margins in pricing, e.g. So, a bad SCOTUS ruling could impact over 200 million Americans not just those in the exchanges and Medicaid.

* Note: The reason for the premium increases are complex, so I will mention them here. Rubio led a Republican move to defund 89% of the payments to insurers for adverse selection (pent up demand for new policy holders) for the first few years, a process used when Medicare Part D was rolled out. Insurers were forced to increase premiums and some left the market with the US owing them money that was promised. The Trump change is more complex. By stopping the reimbursement to insurers for this extra benefit for low paid policyholders, the insurers still honored their commitment to the policyholders. This drove up premiums. Trump said this would only impact insurer profits, but that was not true. The CBO said it increased the annual deficit by $10 billion because the premium subsidies went up as well. The people who ultimately got screwed were those who did not get a full subsidy.

15 thoughts on “Just a quick refresher on the ACA animosity in the Republican Party

  1. Very good summation, Keith. For Trump, I think his hatred of Obama, his intense determination to simply erase Obama’s 8 years from the record books, is the driving factor. But, for the more intelligent republicans in Congress, it is truly a matter of pandering to the insurance industry and big corporations, saving them millions, if not billions per year. Those of us who have numerous pre-existing conditions aren’t considered important to them … it is what it is. Sigh.

    • Jill, what I cannot figure out is with Rubio’s move, several insurers left the market with the US owing them money. I recall one being owed $600 million. The ones who have sued have won, as the US federal government reneged on a deal.

      The provision to restrict profit margins does hinder them, but the ACA offers a huge market for them. So, the ones who remained should be glad that they have the captive market. If the ACA is hobbled, the stock price of the health care companies of insurers in the game may suffer.


  2. I applaud your research and case for ACA Keith. Aside from the profit motive from their supporters: this is ironically a classic Soviet-style era move….try to expunge from society and memory something carried out by someone who they wish to make a non-person ie Obama.
    Sorry I’ve not been contributing of late. Long story involving broken down computers trying to order a new one in Covid era (A tale part Kafa, part Marx Bros, part Three Stooges) and being very immersed in a re-write (Think: Heart of Darkness only Sunny and where Kurtz is worshiping the natives- it’s been as we used to say ‘A Blast’ )

    • Roger, your thoughtful and thought-provoking words were missed. Who else would blend Kafka and the Three Stooges? As for the ACA issue at hand, it is truly a sad day that something that is working pretty good must be killed. The losers are the American people. Keith

  3. Hello Keith. Thank you for the break down. I wonder if the capitalist captive market driven into the arms of the insurers earning them profit backed up by the government payments will out way the regulations restricting them from totally gouging the customers for every cent while dumping the ones costing them money? Or the Republican hate that a black man president managed to do what they have blocked every other president from doing for a century? What will win hate, profit / greed, or deregulations? Hugs

    • Scottie, unless what is and what might be are evaluated in a data driven, thoughtful manner, we all lose. I can’t empasize enough how bad the process Congress used was and how it created a god-awful result that the president celebrated after the House passed it. Then, the Senate did worse. Thirteen men in a room who were not knowledgeable on the issues truly throwing stuff against the wall. McCain saved the Republican party from itself and Americans.

      Permitting insurers to make a reasonable is acceptable, as the need to have an interest, but excessive profit is not good. Keith

      • Hello Keith. You and I have different takes on the best way to serve the medical needs of the US population. I see no need for an insurance middelman needing to make a profit adding to the medical costs. Other advanced countries have national medical systems that work well , cost less than the US pays, and have better results. Hugs

      • Scottie, please know one thing. I am not against national medical insurance, it needs careful and thoughtful study which cannot occur during a campaign. I see it used as a lever right now as Republicans claim the sky is falling (the Dems should have said, let’s study it). Here is what I have been suggesting for about five years – let’s do a pilot. Let’s extend Medicare down to age 62 or even 60 and let’s measure the results. As a former actuary, what this will do is lower the Medicare costs with a slightly younger audience (note about 70% of medical cost is in the final two years of life). It also will lower the ACA costs by making that audience younger. And, let’s measure the results. I would also offer Medicare in counties with only one healthcare option for all ages. Keith

  4. Hello Keith. There is a a key word in your reply. Insurance. You wrote national medical insurance. That is not the same thing as Medicare For All and what other advanced countries I am talking about have. There is a problem with lowering the medicare age that my family hit this year. I have my medicare premium taken out of my monthly SSDI. My Husband turned 65 this year and the law requires him to sign up for medicare even though he had insurance from work or face a penalty. Then my husband lost his job and medical insurance. So his medicare premium is still due, but we have to pay it on a much smaller income, same with the Medicare part D we both had to get. The lowering of the age for the existing medicare won’t solve the problem of for profit pay at receiving medical care. You could lower the Medicare age to 10 but it won’t solve the problem of lack of healthcare if people can not afford to join the program.

    About 44 million people in this country have no health insurance, and another 38 million have inadequate health insurance. This means that nearly one-third of Americans face each day without the security of knowing that, if and when they need it, medical care is available to them and their families.


    I do agree with you the messaging on has been shoddy, badly messaged, and in some cases outright lies. I include all parties and activist in this. There should be study, investigation, simply spouting platitudes won’t fix the problem and gives people a misleading idea of what is on the agenda and what a groups is really pushing for. How many of the candidates on the used the term Medicare For All while meaning very different ideas and plans. Yet there has been study done both here in the US and in other countries. The funny thing is the Heritage Foundation, a very conservative think tank, did a study which showed that a national universal healthcare / Medicare For All plan with government funded single payer will save the US trillions of dollars a year and more as our current system costs increase.

    The truth is we must face the fact that for profit healthcare is at odds with the idea that healthcare is a human right in a country with such a huge income inequality that the US has. As long as we have such high numbers of poor people, under income people, a lower class which struggles simply to make it day to day paying for healthcare is an impossible dream for most of the country. As you say employers want to get the burden off them also, and the people cannot afford it individually. The fact is medicare today with its co-pays and extra costs for part D is more than many seniors where I live can afford. Their SSI payments have not increased as much as the cost of living. Every aspect of costs in every area of the US have increased to kill almost all disposable income and in a lot of cases of seniors it has risen farther than their SSI can cover. Hugs

    • Scottie, please forgive the poor word choice, my friend. I know Medicare for All is not insurance in the way you conveyed it. You do raise a lot of good points that I encourage others to read. Keith

      • Hello Keith. No fear. I respect you as a person and I am willing to listen to your views, think on them, and ponder on if they could be part of my views. We do not have to agree on every issue to be friends. In fact a world where everyone agrees with each other terrifies me as a sterile world where there is no thought or advancement. That is what I think of as the Christian heaven I was taught as a teenager.

        Keith the goal is how to find a better way forward to give healthcare, medical help to every person. I am honest I do not think the capitalist idea that competition in the market will make medical care lower and better. In a for profit system there is only so low any part / agent can go. We have tried that for most of the last 120 years. We need a non-partisan think tank on this issue, but not political one, and with the understanding that profit / capitalism is not the goal. Healthcare for the population regardless of income level must be the goal. Sadly too often the people discussing this are driven by the groups paying them big money to keep the system that makes them making them big money. To often the goal is to keep money in the system. That is not sustainable if we want healthcare for all. Hugs

  5. Pingback: Threat to our own country – short letter to the editor | musingsofanoldfart

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