There has been a lot of discussion and misinformation about the success and failures of the Affordable Care Act.  Several articles have appeared recently discussing the difficulty in repealing the Act and how to replace it with something that will be affordable and provide better quality of care.

New York Magazine had an article explaining that enrollment has spiked despite Trump’s vague promise to repeal and replace.

About 6.5 million more people have signed up for health insurance next year under the Affordable Care Act.  The new sign-ups — an increase of 400,000 over a similar point last year — mean the health care coverage of millions of consumers could be taken away by Trump. Consumers still have until the end of January to enroll.

Salon reported that a new report from Standard & Poor’s projected that 2017 will actually be a good year for the ACA and for insurers participating in the marketplaces, “with more insurers getting close to break even or better.” What the insurers want from the Obamacare marketplaces is for more healthy people to sign up and pay for coverage. This report suggests that might happen.

As for those who’ve already benefited from the ACA, the Urban Institute just put out a big study breaking down what kinds of people have gained coverage over the past few years. It found that there’s been a nearly 40 percent drop in the national uninsured rate since 2010, and that “men and women of all ages and across race, ethnicity, and education levels benefited from gains in coverage.” Significantly, the report found a major disparity in coverage gains when comparing states that cooperated with ACA implementation and those that did not: “States that expanded Medicaid under the ACA saw larger percentage reductions in their number of uninsured residents than did states that chose to not expand Medicaid (45 percent compared with 29 percent).”

This rash of year-end data provides ammunition for the law’s supporters to make a plausible counterargument: More people are signing up for coverage, the marketplace outlook is getting better, and many millions of people have already benefited.

NPR explained the difficulty with repealing ObamaCare for one big reason: Republicans have pledged to repeal the taxes that Democrats used to pay for their health law. Without that money, Republicans will have far less to spend on whatever they opt for as a replacement.

The health law’s subsidies to individuals buying insurance and the Medicaid expansion are funded by two big pots of money.

The first is a series of taxes, including levies on individuals with incomes greater than $200,000, health insurers, makers of medical devices, brand-name drugmakers, people who use tanning salons, and employer plans that are so generous they trigger the much-maligned “Cadillac Tax.” Some of those measures have not yet taken effect.

The other big pot of money that funds the benefits in the health law comes from reductions in federal spending for Medicare (and to a lesser extent, Medicaid). Those include trims in the scheduled payments to hospitals, insurance companies and other health care providers, as well as increased premiums for higher-income Medicare beneficiaries.

CBO estimated in 2015 that canceling the cuts would boost federal spending by $879 billion from 2016 to 2025.  However, the Congressional Budget Office estimated in early 2016 that repealing those provisions would reduce taxes by an estimated $1 trillion over the decade from 2016-2025.

“Repealing all the ACA’s taxes as part of repeal and delay only makes a true replacement harder,” wrote Loren Adler and Paul Ginsburg of the Brookings Institution in a white paper out Monday. It “would make it much more difficult to achieve a sustainable replacement plan that provides meaningful coverage without increasing deficits.”

Republicans will have two options if and when they try to replace the ACA’s benefits — not paying for them at all, thus adding to the federal deficit or cutting Medicare and Medicaid leaving millions of Americans without any coverage.

ObamaCare’s core elements remain highly popular including protection for people with pre-existing conditions and the availability of financial assistance for people who can’t afford coverage on their own ― which, in a Henry J. Kaiser Family Foundation poll, 80 percent of Americans said they support.

The same Kaiser Foundation poll found that roughly half of Americans want to keep Obamacare in place or expand what it does. Another 17 percent merely wants Congress to scale it back, while just over a quarter want full repeal ― and even that enthusiasm wanes when respondents learn that repeal might mean eroding the law’s consumer protections.


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