The fate of the Affordable Care Act (ACA) will be the big issue in the upcoming mid-term congressional elections, with Republicans and their allies continuing to press for repeal, believing that it is a winning issue with voters (or at least the base voters who lean Republican). Opinion polls are not as clear-cut, though. Although more Americans continue to have a less favorable than more favorable view of the law, most oppose outright repeal.
But no matter what the politicians say in the election, the ACA is here to stay, at least as long as President Obama is in the White House and probably much longer than that. Although we don’t have the final enrollment numbers from October 2013 through the first 3 months of 2014, when the first open-enrollment period for the marketplace plans created by the ACA ended, it is likely that total enrollment as of April 15 will fall between 15 and 18 million people, nearly 8 million in the marketplace plans, another 5 to 7 million in Medicaid, and between 1.6 and 3 million young adults on their parents’ plans.
Because of the ACA, tens of millions more Americans have no lifetime or annual limits on coverage, and seniors enrolled in Medicare have better coverage of prescription drugs and preventive services. No one, regardless of health status, can be turned down or charged more by insurers. These enrollment numbers will likely increase over the next several months and years as more states decide to expand their Medicaid programs and as the next wave of marketplace enrollment occurs in fall 2014.
Politicians, regardless of their political leanings, can count. As more voters benefit from the ACA, I see no scenario where Congress will reverse course, even if the Republicans take control of the Senate next year. (And, of course, President Obama would veto any major changes to the ACA.) At some point in the future, but unfortunately not for another election cycle or two, I believe that our politics will shift to a new normal, where the ACA is accepted by both political parties (like Medicare, which itself was initially very controversial, is today), and the debate will shift to how to revise it, not repeal and replace it. I doubt that will happen until the next presidential election in 2016, though.
In the meantime, four things could be done to make the ACA better, learning from the experiences, good and bad, in this first year of enrollment.