Republican critics of the Affordable Care Act have long described it as a house of cards on the verge of collapse. And they continue to be wrong. A record number of people have signed up for health insurance for 2017 on the federal exchanges created by the 2010 law.
Nearly 6.4 million people have signed up for coverage, which is about 400,000 more than at a similar point last year. Among them were 2 million people who did not participate in 2016, some of whom might have previously been covered through an employer. The number of enrollees does not include many millions of people whose policies will be automatically renewed or who live in states like California, Minnesota and New York that have their own marketplaces.
By the time open enrollment ends early next year, the Department of Health and Human Services estimates 13.8 million people will have signed up nationwide. The percentage of Americans without insurance is steadily declining, hitting a record low of 9.1 percent in 2015, the most recent year reported.
If President-elect Donald Trump and Republican leaders in Congress carry out their promise to repeal the law, they will be taking away health insurance from millions of people — the ACA also expanded Medicaid to cover about 14 million more low-income and poor people.
When the Obama administration announced in October that premiums would rise by 25 percent on average for midlevel plans on the federal exchanges, Republicans predicted that this would doom the system. They ignored the fact that most people would not have to pay more because federal subsidies would rise to account for the higher premiums charged by private insurers. About 77 percent of people eligible for the coverage on the exchanges can find policies for $100 a month or less.
Still, the cost of insurance, deductibles and co-payments is too high for many people, especially middle class families that earn too much to qualify for subsidies. But the solution is not to take away the benefits of the law but to strengthen it. Costs could be lowered if more young and healthy people were encouraged to sign up to spread costs over a larger pool of people.
If lawmakers are moved by nothing else, they should think about the political costs of repealing the Affordable Care Act or crippling it with piecemeal changes. Many of the people who benefit from health reform live in states that voted for Trump and down-ballot Republicans. The Kaiser Family Foundation estimated that residents of Florida received $5.2 billion in subsidies to buy health insurance as of last March, more than in any other state. More than 600,000 people in Ohio are enrolled in Medicaid thanks to the law. And in Texas, there are 4.5 million people with pre-existing conditions who cannot be denied coverage under the law or be charged higher prices.
Treating the Affordable Care Act as a punching bag during a political campaign is one thing. But it is quite another to destroy a law that is helping so many people.