When it comes to the Affordable Care Act, Tony Richards is torn.
On the one hand, he acknowledges the law has improved health care for the poor and the sick. He supports the provision that requires insurers to cover people with preexisting conditions. He says the ACA is a step towards better care for all Americans.
Yet his own experience with the law has been fraught.
He has faced a billing snafu that left him and his family without coverage for four months. A kink in the system granted one of his twin daughters insurance while denying the other. And the plan his family can afford, even with tax credits, is still too expensive at $756 a month and $6,500 in deductibles, Mr. Richards says. It also leaves them with limited choices in providers in the St. Louis area, where they live.
“It’s worked out wonderfully for lots of people. I do feel it’s certainly a step in the right direction,” says Richards, a self-employed director and producer. “But at the same time, there’s terrible flaws in the system. Nobody should have to go through hell to get medical insurance.”
Much of the debate around the ACA has had to do with conflicting party values. Polls show that party affiliation, almost more than anything else, is a key predictor of support for the ACA. A Friday vote by the Republican-led United States House of Representatives began the process of repealing the law. On Sunday, Democrats have called a national “day of action” with rallies nationwide to save it.
But for Americans like Richards, it’s less about party ideology than how the law has affected their everyday spending, security, and health. They acknowledge that government may have to spend more to protect the nation’s most vulnerable.
But they hope lawmakers find a way to do so while ensuring health care that is worth the cost.
“The partisans go into their corners … and that’s why the debate has been so contentious in part,” says Lanhee Chen, a public policy expert and research fellow at Stanford University’s Hoover Institution. “But by and large … the biggest issue with the law has been affordability. It hits people personally.”
Room for agreement?
Data suggest there’s room for the issue to transcend party lines.
A Kaiser Family Foundation survey published this month found that proponents of repeal are more likely to waver when they consider the risks it might pose to the 20 million people who gained coverage through the law. At the same time, opponents become more amenable to repeal when presented with evidence that some consumers have seen their health care costs soar after the ACA was passed, according to the survey.
Alexander Travison, a Los Angeles photographer, says depriving the poor of the ACA’s benefits “would be criminal.” After years without coverage, Mr. Travison enrolled in Medi-Cal, California’s version of Medicaid, following the law’s passage. When his photography business picked up, Travison switched to Covered California, the state’s online exchange program.
Today, Travison pays about $50 a month for coverage worth nearly $500; the federal government subsidizes the rest. As someone who makes $18,000 a year, has been diagnosed as pre-diabetic, and sees a doctor every three months, he says, “it’s a big relief off my mind to have insurance like this.”
That doesn’t mean Travison approves of the way the law has resulted in rising premiums for other families. “I realize a lot of the people in the middle class are getting squeezed,” he says. “That’s also not right.”
Horace Seely-Brown III remains convinced the ACA is not just flawed but failing. Like most conservatives, he had seethed at the way the Obama administration pushed the ACA through Congress without any Republican support. He sees the law’s individual mandate – which requires all Americans to enroll in a minimum level of health insurance or face a penalty – as government needlessly inserting itself into the lives of citizens.
“You should be able to pick the policy you want,” says Mr. Seely-Brown, who runs an out-of-state textile business from his home in the Chicago suburb of Northbrook, Ill. “Let people choose how they handle their medical affairs, not be dependent on government.”
But even he allows that states alone can’t support a health care policy that provides coverage for vulnerable populations.
“Should they pull the rug out from under all these people? No,” Seely-Brown says. “The [federal government’s] going to have to subsidize some of these people.”
'No easy way'
Despite hints of common ground, some say compromise isn’t possible without hurting someone.
“There’s just no easy way to do this without causing pain for somebody,” says Sabrina Corlette, a research professor with the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute in Washington. “The Affordable Care Act made the system better if you were sicker, poorer, and older; but if you were young, healthy, and rich, you were worse off in many cases.”
Between 2010 – when the law was signed – and the first three months of 2016, the share of uninsured adults in the nation dropped from 15.7 percent to 8.6 percent, a record low. The majority of the increase was due to the expansion of Medicaid under the ACA to include single adults and others who were previously ineligible for the program.
To scrap the law now could disrupt the new system, putting those 20 million people at risk of losing coverage, observers say. It could also force hospitals and health centers to pull back on the services they’ve begun funding through the newly insured.
“Transforming the health care system was a lot of work for us, and we feel like we’ve just turned a corner toward the great stuff,” says Elizabeth Benson Forer, executive director of Venice Family Clinic, a Los Angeles community health center. “To blow that all apart out of political expedience … it’s upsetting.”
Some conservatives acknowledge the risks that may emerge from a repeal that doesn’t come with a well-thought-out replacement. But the system is broken, they say, and it is possible to develop a new policy that would keep the best elements of the ACA while improving upon its overall structure.
“We do need to figure out how to assist people who are low-income … and have massive health conditions,” says Mr. Chen at Stanford.
“But you want to create a sustainable system,” he says. “The Affordable Care Act thinks too much about access without thinking enough about cost. I think it should be flipped. A new system has to be focused on reducing costs, and from that I believe will come greater access.”
For now, Americans can only wait to see how Congress’s efforts to strip the ACA of funding will affect their own lives – and what policy Republican lawmakers will come up with in the weeks to come.
Some, like Travison, worry. “I feel kind of helpless,” he says. “It weighs heavy on people’s minds.”
Others, like Richards in St. Louis, hope for the best. “I felt that health insurance was in a sad state prior to the ACA, and I still feel it’s in a sad state,” he says. “But maybe we’re taking steps in the right direction. Nobody has all the answers, and I think we should embrace all these ideas.”