Last semester, I taught a course on US health insurance reform politics and policy for Duke Sanford School of Public Policy students. One option for the final was to respond to a prompt that asked if the ACA is sufficienctly embedded into the US health care and political system that it is only subject to “normal” thermostatic politics instead of existential program politics. In 2017, the law faced an existential threat. Would it face a similar threat in 2025 under a Republican Trifecta? That is the short version of the question.
This week the Centers for Medicare and Medicaid Services (CMS) released the Week 8 (through 12/23/2023) Open Enrollment Snapshot report. I want to pull out a few numbers.
All Marketplaces 20,353,461
Florida 4,034,546
North Carolina 996,250
Texas 3,291,543
Three states that are core parts of the GOP coalition have over 40% of total ACA on-exchange enrollment. Those are substantial facts on the ground that create coalition splitting cleavages.
If a student brought up these types of numbers in their final essay, I would have to think that they are really engaging with the assignment.
Baud
The FL number is eye popping. That’s 20% of the state.
Fair Economist
Unfortunately people reliant on Obamacare still seem very willing to vote to screw themselves over by putting Republicans in office. I figured back in 2014 all the people on Obamacare in places like Kentucky would tilt those states back to us but it hasn’t happened.
Not sure why, but that’s my observation.
Old School
@Fair Economist: Because Trump will replace it with a much better system.
Baud
Health related
Barbara
@Baud: The numbers are disproportionately high for any state that hasn’t enacted Medicaid expansion. I would bet that the crossover population (would be eligible for either option if the state had expanded) is substantial in both Texas and Florida.
There might be other reasons for why it is so high — high level of seasonal employment and/or employment in the hospitality industry (notoriously below the national average in offering employee benefits), and so on.
Barbara
@Fair Economist: Even in Florida, the rate is, as Baud said, around 20%. It’s just possible that this 20% is in the part of the population that is already more likely to vote for Democrats. It’s rare for that proportion to dip below 40% almost anywhere.
AlaskaReader
The answer is yes.
Barbara
@AlaskaReader: I am not sure this is correct. I am still somewhat shocked that it survived first time around, after having been in effect for only two full years, which were fairly rocky for both plans and their members. Eight years later. many markets have stabilized, and a lot of people now get coverage through an ACA plan. It’s not that anything is 100%, but at a minimum, the Senate would find a way not to vote on it if it came to that.
It can still be sabotaged, however, by executive actions.
Brachiator
@Baud:
I must admit that I never really thought about it. It never seemed like much of a mystery.
I recently had a number of lab tests done. Blood was drawn and I had to leave a urine sample. None of the test results evaluated the color of urine.
Interesting science story though, if it creates new medical possibilities.
And I guess we will always be warned about not eating yellow snow.
Brit in Chicago
@Barbara: “It can still be sabotaged, however, by executive actions.” As it was greatly helped and strengthened by executive actions over the last two years and 354 days or so. (Don’t miss a chance to remind people of what a large and positive difference the Biden administration has made to many facets of life in this country. More to be done, of course.)
Brachiator
Good question. I think that the GOP would abolish it if they get a chance, but will always offer some false choice that claims to be better.
Also, has enrollment declined, held steady or increased in the three states noted above?
AlaskaReader
@Barbara: With a Republican trifecta nothing is safe.
If Republicans gain the opportunity to return healthcare insurance to corporate control, they’d jump at the chance.
Republicans would do away with the ACA in a heartbeat and their voters would cheer the loss of their own better interests.
JCJ
The previous post from the esteemed Betty Cracker to me verifies that the ACA would be at risk. Medical care during pregnancy would seem to be not very controversial, and intervening in a situation of a non-viable fetus should be a given. Despite that people vote for these politicians who enact these horrible laws that do not allow proper medical care. I cannot imagine these same people would mind losing health care coverage at the altar of Trump.
Fair Economist
@JCJ: You beat me to it. Republicans are so wrapped up in some combination of their media bubble and their hatred of anybody besides themselves that they’ll wreck any Democratic goal or program, regardless of potential political consequences. And the media will do its best to support them.
ronno2018
Subsidy cliff will end in 2025 and that might affect me if I retire before then. Maybe others currently with that benefit will understand they could be impacted?
AlaskaReader
Here is an example of Republicans handing insurance rate control to the insurance industry despite the downside costs to be borne by the public.