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.