The Tradeoffs Podcast: After 10 Years of the Affordable Care Act, Replacing Medicaid, and Leaving the Insurance Industry with a Block Grant

The organization is a health policy news organization. Dan is the editor in chief. Reporter Ryan Levi produced this story for the Tradeoffs podcast. Tradeoffs’ Deborah Franklin adapted this story for web. You can listen to the interview on the internet.

The ACA was a change. Insurance companies have to provide coverage regardless of your health. If you’re sick, they can not charge you a higher premium. And there are a set of essential benefits that all insurance companies have to provide.

And if we look back at President Trump’s presidency, his budgets proposed converting both the Affordable Care Act and Medicaid into a block grant to states, meaning removing federal rules and giving states a lump sum of money and giving states flexibility in how to use that money. We’ve seen similar plans, for example, from a group of conservative Republicans in the House that would also convert Medicaid in the ACA into a block grant to states, remove federal protections in the insurance market, and cut federal spending by $4.5 trillion over a decade.

We’ve been polling for more than a decade and a half about the ACA. … After it passed, it was quite controversial as a topic of debate. That changed when Republicans tried to repeal and replace it in 2017. For the first time, the ACA was clearly more popular than not and has grown more popular since then. Now, 62% of the public views the ACA favorably. That’s a far cry from when half the public viewed it negatively. More and more people have benefited from the law since its main provisions went into effect over a decade ago.

At a campaign stop in Pennsylvania last week, House Speaker Mike Johnson told a crowd that “massive reform” of the health law is needed, adding no specifics. But he did promise a “very aggressive first-100-days agenda” if Trump wins. “Health care reform’s going to be a big part of the agenda,” Johnson said.

Harris warned Americans about what might happen if the ACA were to be repealed during a speech on Tuesday in Washington D.C. If Donald Trump dismantles the Affordable Care Act, he will make you pay even more for insurance, just like when insurers had the power to deny people with preexisting conditions.

The upcoming elections could have “enormous” impact on the law, says Larry Levitt, an executive vice president of the nonpartisan health policy research organization KFF. Levitt has studied the ACA since its inception.

He recently shared insights into the ACA’s track record and discussed what “massive reform” from Republicans might look like on the health policy podcast Tradeoffs. Here are highlights from that conversation.

The impact has been tremendous. If you had a preexisting condition before the Affordable Care Act — a cancer diagnosis, multiple sclerosis, being pregnant, being overweight — if you tried to buy insurance on your own, you would be denied. If you have a mild preexisting condition, you might be offered health insurance but will have to pay a higher premium or have benefits thrown out.

They had to care for mentally ill people. They had to pay for maternity. Substance abuse treatment was covered by them. All of that costs money. Premiums went up. Now, the [portion of the premium] that people pay out of their own pockets went down. And that’s because of the subsidies the federal government is providing to help people pay for their health care.

The quality of coverage has gone up. The benefits — the stuff that insurance companies have to provide — are now more comprehensive. It covers preexisting conditions. It covers all of these required benefits.

It can be hard to get an appointment with a doctor if the plan has a narrow network and the insurance company won’t pay for it. It’s one step towards trying to make sure that having health coverage also means having access to health care.

The Fate of the Affordable Care Act in the U.S. Congress During the 2016 Elections: The Dreamers’ Journey Through Marketplace Health Plans

Though the fate of the Affordable Care Act has played a role in presidential elections in the U.S. for more than a decade, this race has been different. Apart from a few cameos, the 14-year old law — often called Obamacare — has been largely off-stage, as immigration, the economy and democracy dominate the fight between Vice President Kamala Harris and former President Donald Trump.

The rule that allows low-income people to enroll in marketplace health plans at any point of the year is new in the year five. Medicaid works for people with low incomes.

Depending on who will be elected President and whether or not Congress will keep the federal subsidies that have made the health plans affordable, this could be the high watermark forEnrollment in these plans.

Most Americans have access to insurance through their jobs or through a public program. But still, this program has a big impact. As enrollment in the marketplaces set new records in the last few years, the number of uninsured Americans has dropped dramatically.

Premiums are still affordable for many people and there are more plan options than ever. “I think this is really reflecting a turnaround in the ACA marketplaces,” says Cynthia Cox, who directs the Program on the Affordable Care Act for KFF, a nonpartisan health research organization.

“Under President Biden and Vice President Harris, more Americans have access to a doctor, a hospital through their own health insurance than ever in the history of the country,” Secretary of Health and Human Services Xavier Becerra tells NPR. After this year’s open enrollee, he says, “I have no doubt that we’ll see another record of Americans with health care coverage.”

One group that’s newly eligible for these subsidized marketplace plans is Deferred Action for Childhood Arrivals recipients, also known as Dreamers. Secretary has said that 100,000 people are expected to enroll.

“It’s a good day for all these folks because for the longest time they’ve been working [and] paid taxes and not had a chance to get their coverage through the Affordable Care Act — that changes,” he says.

Camila Bortolleto is one of the Dreamers who’s been waiting for this. She came to the U.S. with her family from Brazil when she was nine. She no longer has health benefits and lives near Danbury, Ct., uninsured. That has meant, for example, paying out of pocket at urgent care when a dog bit her a few weeks ago.

“It is stressful,” she says. I have to get a checkup. I need to see a dentist. And you never know when a random emergency’s going to strike.” She planned to sign up as soon as enrollment opened on Friday.