Now that the House Republicans have presented their long-awaited plan for repealing and replacing the Affordable Care Act, it is a good time to add another “re” word to the national dialogue: reflecting.
Marianne Udow-Phillips is executive director of the Center for Healthcare Research & Transformation, a non-partisan health policy center based at the University of Michigan.
As the Republicans’ American Health Care Act moves through the legislative process, policy makers should compare the American health insurance markets before the ACA to where we are now when deciding where to take the insurance markets next. And, it is crucial for them to understand what many of the citizens calling for the law to be “repealed and replaced” likely mean by that phrase.
Then and now: Health insurance in Michigan
Before the ACA, more than 12 percent of Michiganders – more than 1 million people – were uninsured. In 2015, the most recent data available following the ACA’s coverage expansions, only 6.1 percent of Michiganders (nearly 600,000) were uninsured, cutting the percentage of uninsured citizens in half.
Despite some pundits’ fears, for the most part, employers did not drop coverage as a result of the ACA. In fact, while small employers (less than 50 employees) were dropping coverage at high rates prior to the ACA (which is one reason the ACA was passed), the rate of decline in small employers offering coverage moderated since the ACA’s implementation, leveling out at just above 30 percent (although down from over 50 percent in 2002).
And, despite the widespread publicity in the fall of 2016 about individual market destabilization and issues in many parts of the country, Michigan continued to have a robust, competitive individual market in most areas of the state with many health plans and product offerings, with 167 marketplace plans, according to the state’s Department of Insurance and Financial Services.
And, premiums in the most recent individual market open enrollment were competitive, with an average and in fact, somewhat lower than in the employer market.
Source: Kaiser Family Foundation: How ACA Marketplace Premiums Measure Up To Expectations/2016 Employer Health Benefits Survey
As a result of the ACA, the individual market in Michigan saw considerable growth compared to before the ACA’s coverage expansions began in 2014.
Given this picture, which seems largely favorable, what is it that people mean when they say that they want to replace the ACA? For consumers in Michigan and throughout the country, deductibles have increased substantially since the pre-ACA days.
And, in a national survey, when asked about priorities for an ACA replacement plan, consumers overwhelmingly (67 percent) reported wanting the top priority to be lowering the cost of health care. Thirty-seven percent wanted the law repealed, and 35 percent wanted federal spending on health care to decrease, and the role the government plays in health care to similarly decrease.
Bottom line: When most people in Michigan and nationally say they want to “repeal and replace” the ACA, they do not necessarily want to lose coverage or return to the pre-ACA world. They believe that the ACA has not done enough to lower consumers’ health care costs.
As with the ACA, there are winners and losers in the American Health Care Act. In general, winners include the young and healthy; the well-off, who would get significant tax benefits from the act’s proposed changes; and those less likely to need health insurance. The older, sicker and lower income would face higher costs and/or less coverage.
This week, the nonpartisan Congressional Budget Office estimated that under the AHCA, 14 million people will lose coverage in 2018. The number of uninsured rises to 24 million by 2026. Analyses published since the House Republicans unveiled the AHCA – from Forbes Magazine opinion editor Avik Roy and the non-partisan financial services company Standard and Poor’s to the nonprofit public policy organization The Brookings Institution – reached similar conclusions before the CBO released its score.
It seems that proponents of the AHCA are not listening to the message that citizens in Michigan and nationally are giving policy makers: fix the ACA so that it can provide better quality, more accessible and lower-cost health coverage.
A bill resulting in 14 million Americans losing coverage in 2018 is not what citizens are asking for.