Why So Hard to Kill the Affordable Care Act?


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For years, Republicans vowed that if they ever got control of the White House and both houses of Congress, the Affordable Care Act would quickly end up in the trash heap. As of January 20, those pieces were firmly in place.

Yet nearly 3 months later, the GOP appears no closer to enacting a repeal-and-replace bill than they were when Barack Obama was sitting in the Oval Office.

House Republican leaders have been unable to forge a consensus among its conservative and moderate wings as to what should come after the ACA. One bill had to be pulled from a floor vote when it became clear that neither the GOP’s Freedom Caucus nor Democrats would support it. And, earlier this week, a push led by top administration officials to appease the Republican conservatives — by making certain ACA elements retained in the GOP plan optional for states — was quickly declared dead on arrival.

MedPage Today asked physicians and policy experts why President Obama’s signature legislation is so hard to kill and whether Republicans might give up trying.

“Advocacy against the AHCA [American Health Care Act, the GOP’s initial repeal-and-replace bill] was broad and intense, with health care and public health organizations repeatedly raising concerns about health insurance coverage, access, and costs, including proposed dramatic changes to Medicaid funding that would preferentially hurt low-income people (including children), and risks of coverage gaps for those with chronic and pre-existing conditions,” wrote Jan Carney, MD, MPH, associate dean for public health and professor of medicine at the University of Vermont in Burlington, Vt., in an email.

Carney underscored the importance of the Congressional Budget Office’s report projecting a dramatic increase in the number of uninsured Americans — 14 million more in 2018 and 24 million more in 2026.

She also highlighted an April 4 Kaiser Family Foundation poll, which found 75% of Americans felt that Congress should work on fixing the ACA instead of repealing it.



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