Analysis by Zachary B. Wolf, CNN
(CNN) — Most Americans probably think the fight over Obamacare, more properly known as the Affordable Care Act, has been done for years.
Democrats enacted the law without Republican help in 2010, and Republicans largely spent the next seven years actively trying to repeal it.
That congressional repeal effort effectively ended in 2017, even though Republicans held the White House and both chambers on Capitol Hill at the time, when then-Sen. John McCain joined Democrats and a few Republicans with his dramatic thumbs-down vote on a hastily assembled “skinny repeal” bill.
The country discussed Obamacare over the course of multiple elections, Capitol Hill debates and Supreme Court decisions. The law is here to stay.
More people are signing up for 2024 coverage through the federal and state exchanges than ever before. Open enrollment lasts until mid-January in most states. Another state, North Carolina, is finally implementing its expansion of Medicaid coverage for low-income Americans. Only 10 states continue to refuse to expand their Medicaid programs.
The main problem back in 2017, which former President Donald Trump now says was a “low point” for his party, was that Republicans did not have a comprehensive plan to replace the landmark health care law and they couldn’t get unanimity in their party even for a pared-back attempt to hollow the act out.
So it was a little surprising to see Trump share a Wall Street Journal editorial – about bipartisan frustration with consolidation in the health care industry being used by corporations to get around profit caps in the health law – to argue that Republicans should “never give up” trying to terminate the law.
The suggestion was met with crickets from fellow Republicans on Capitol Hill, who haven’t thought seriously about repealing the law in years. Democrats immediately tried to seize on his comments. Even Trump seemed to acknowledge that his suggestion was out of whack with the country when he calibrated it on Wednesday.
“I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!” he wrote in an overnight post.
Set aside that Trump’s lack of a detailed health care plan was a main reason he could not repeal the law in the first place. More importantly, the moment most of the country started thinking Obamacare did not suck was about the time Republicans failed to repeal it.
The health policy research organization KFF, previously known as the Kaiser Family Foundation, has used a regular series of tracking polls to chart public approval of the law since then-President Barack Obama signed it in 2010.
It is interesting to look at the trend line of those polls, which show the law has grown more popular in recent years and now has a favorable view among three-fifths of all Americans.
That favorability extends to young people and old people, White people and people of color. Democrats are broadly supportive of the law and independents mirror the three-fifths approval of the country at large.
Republicans are the only subgroup in KFF’s polling that have continued to view the law unfavorably, although even their opposition has fallen somewhat. In the most recent KFF polling, about one-fifth of Republicans held a favorable view of the law.
The last time the Affordable Care Act was not viewed more favorably than unfavorably by all Americans was in April 2017, not long after Trump took office and not long before McCain saved the law with his dramatic vote that July.
Exit polls from presidential elections confirm the growing acceptance of the law. In 2016, when Trump won the White House while losing the popular vote, about the same portion of voters said the law went too far (47%) as those who said it didn’t go far enough or was about right (48%).
In 2020, when Trump lost both the White House and the popular vote, exit polls asked if the Supreme Court should affirm the law (51%) or overturn it (44%).
None of this means the US health care system is perfect and running smoothly
It is not. When I went to KFF’s website to look up the organization’s Obamacare polling data, I noticed a post by KFF’s CEO Drew Altman about how the cost of health insurance can be unaffordable, particularly for people employed at small businesses.
He also cited data in a recent KFF survey in which between 20% and 30% of lower-income Americans with health coverage through their employers reported having trouble paying medical bills.
There are plenty of other issues, many of them covered year-round by CNN’s Tami Luhby.
Preventive-care coverage is at risk. While the Affordable Care Act has largely withstood court challenges over the years, they have not stopped. A federal judge in Texas invalidated the law’s requirement that certain preventive care – statins and some cancer screenings, among other things – be covered at no cost. That case is working its way through the appeals process. Read more about efforts to keep the coverage in place.
Multiple states have still not expanded Medicaid. While most of the country has expanded Medicaid coverage to help lower-income Americans afford health care, big states like Florida and Texas, along with Wisconsin and much of the South, have not. Georgia is experimenting with a work requirement for some low-income people to obtain Medicaid coverage.
There is a coverage hole. Millions of lower-income Americans in these non-Medicaid-expansion states are both not eligible for Medicaid coverage they could qualify for in other states and also not eligible for subsidies to buy insurance through the Affordable Care Act exchanges.
Unwinding Medicaid coverage. More than 11 million Americans who were able to temporarily hold onto their Medicaid coverage during the Covid-19 pandemic have lost it under an unwinding process that will continue into the spring, according to KFF. They will need to find coverage through an employer or on the Obamacare exchanges if they can’t requalify for Medicaid. Read more about Medicaid eligibility.
Premiums are more expensive. The cost of care on the exchanges, like just about everything, is up. The average increase is 4%, although there are many plans available on the exchanges, which vary from state to state. Nearly all of the people who obtain coverage on the exchanges qualify for help paying premiums from the federal government, and these subsidies largely shield them from the rate hikes. Read more about 2024 premiums.
Prescription drugs prices are ever an issue. Drugs generally remain more expensive in the US than in other countries, although a new provision enacted by Democrats to allow Medicare to negotiate prices for a few drugs could help start driving down costs on certain widely used medications. Driving down drug costs remains a consistent pledge of US politicians from both sides of the aisle. There is no agreement on how to accomplish it.
These are valid policy debates on which lawmakers could be working together.
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