How long until the ACA is dismantled?

[Omy]

Assuming Republicans have all three branches (and SCOTUS) how long will it take before they get rid of the ACA? Will my 2025 coverage be interrupted? Will it take a few years?

To clarify, I'm looking for best guesses as to how quickly it COULD be thrown out so I can get an idea on how quickly I will need another plan. If our current pre-existing conditions coverage for individuals goes away, I may need a job or more likely a move to another country to be able to protect my health.

So IF the ACA is tossed, can that be done quickly since they wouldn't have to come up with a backup plan? Am I correct to assume dismantling the ACA would be easy compared to putting new legislation in place?

[khizr]

Nobody knows.

It could end in the first 100 days, it might never be removed, he might just name it TrumpCare :)

Nobody knows the answer until it happens; the chaos is real.

[rantk81]

The TCJA expires after 2025, so I would imagine that the first order of business for them would probably be to hammer out an extension/modification to that.

It really depends on how "close" the make-up of the House ends of being, if they will have a lot of internal bickering about details and if they draw it out over a long time.  Otherwise, if they have a big majority, then they will probably be able to ram some tax law changes through really fast, then they could move on to other things.  I'd estimate an inhumane (anti-) immigration bill would be next on their to-do list.  Probably everyone who is on, or has a family member on, DACA or Temporary Protected Status, or a work visa, would be at risk of having their lives up-ended or ruined.

They've got a 2 year clock to do whatever they want until the mid-terms when things could change, but also could give them 2 more years of controlling everything.  There hasn't been much rhetoric about the ACA (other than what might be in Project 2025), so I don't know where it lands on their list of priorities.

[chasesfish]

Unpopular opinion:

The "brokeness" of health care is so severe, there is no easy legislative solution.   The US is in the position they are because of fifty years of politicians passing / promising benefits without corresponding funding mechanisms:

- Required ER care without payment created the hospital overbilling mess, but no politician will reverse the guaranteed access to ER care or expand govt paymetn to all ER care. 

- Medicare is "mandatory spending" without payroll taxes being adjusted annually to match spending is responsible for 1/3 to 1/2 of the annual deficit (and why every president will "borrow more money" than the last one).   No politician is willing to either increase those taxes or discuss if the country should be borrowing this much money for elderly care.

- The ACA gutted it's own funding mechanism / ability to expand the insurer pool via waivers / cancellation of the coverage requirement.  However the ACA guaranteed issuance of coverage, which no politician will reverse.    The number of 20-50yr olds opting out of the insurance pool continue to make this unaffordable.


I would worry less about the ACA being dismantled and more about the ever accelerating cost until we elect people willing to have an adult discussion about more tax revenue or requiring all citizens to be part of the insurance pool.   Right now candidates choose to demogauge any politician who presents the necessary but unpopular solutions.   Starting with doubling to tripling the payroll tax to cover the current medicare obligations and potentially fixing the ER payment issue would be a good start, followed by the requirement of everyone to be on insurance or they don't receive their tax refund.

[jim555]

Nobody knows.  The problem is they have no plan to replace it and it is VERY complex.  The ACA is highly ingrained now and you just can't remove it.  They probably nibble around the edges.

[classicrando]

- Required ER care without payment created the hospital overbilling mess, but no politician will reverse the guaranteed access to ER care or expand govt paymetn to all ER care. 

Are you sure about this?  Like, I wouldn't be at all surprised if the next administration dumped guaranteed access under some rhetoric about not funding moochers, loafers, and/or illegals, and how this will transform into savings for Real Americans^TM.

Anybody that "ought" to have access will already have insurance and be able to prove it.

[chasesfish]

Are you sure about this?

The obvious solution would be to cover these under medicare/medicaid and increase the payroll taxes correspondingly.

However, anyone who does this will be pounded twice in a campaign cylce for raising taxes, once in the primary and once in the general.

So no, I don't see the United States becoming India and turning away people unless they prepay for ER care.

[elysianfields]

- The ACA gutted its own funding Republican Congress, as part of the TCJA, gutted the ACA’s mechanism / ability to expand the insurer pool via waivers / cancellation of the coverage requirement.  However the ACA guaranteed issuance of coverage, which no politician will reverse.    The number of 20-50yr olds opting out of the insurance pool continue to make this unaffordable.

FTFY.

I would worry less about the ACA being dismantled and more about the ever accelerating cost until we elect people willing to have an adult discussion about more tax revenue or requiring all citizens to be part of the insurance pool.   Right now candidates choose to demogauge any politician who presents the necessary but unpopular solutions.   Starting with doubling to tripling the payroll tax to cover the current medicare obligations and potentially fixing the ER payment issue would be a good start, followed by the requirement of everyone to be on insurance or they don't receive their tax refund.

To be fair, the ACA has been doing a pretty good job of reducing overall health care costs, and would have performed even better had the Congress not enacted the TCJA.

[classicrando]

Are you sure about this?

The obvious solution would be to cover these under medicare/medicaid and increase the payroll taxes correspondingly.

However, anyone who does this will be pounded twice in a campaign cylce for raising taxes, once in the primary and once in the general.

So no, I don't see the United States becoming India and turning away people unless they prepay for ER care.

We are already turning people away for care as a result of anti-abortion laws.  You think turning people away for an inability to pay is a bridge too far?

[reeshau]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

Given that this was not a campaign issue this time around, I think the GOP would catch he'll if they tried this, before they accomplished the things they did promise.  That, and pissing of 20M voters wouldn't be smart.

[bacchi]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

Given that this was not a campaign issue this time around, I think the GOP would catch he'll if they tried this, before they accomplished the things they did promise.  That, and pissing of 20M voters wouldn't be smart.

If you need to cut $2T from the budget, getting rid of health care subsidies is a good place to start. Because we know it ain't coming from the defense budget.

That'll leave the ACA without subsidies, which will make it too expensive for many of its enrollees.

[reeshau]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

Given that this was not a campaign issue this time around, I think the GOP would catch he'll if they tried this, before they accomplished the things they did promise.  That, and pissing of 20M voters wouldn't be smart.

If you need to cut $2T from the budget, getting rid of health care subsidies is a good place to start. Because we know it ain't coming from the defense budget.

That'll leave the ACA without subsidies, which will make it too expensive for many of its enrollees.

If your campaign promises will raise the debt by $7.75T anyway, why worry about rounding figures?

https://www.crfb.org/papers/fiscal-impact-harris-and-trump-campaign-plans

[tooqk4u22]

I think ACA and prior existing condition part will largely remain in tact.  Buuutttt.......

I think there is significant risk to the subsidies as they expire in 2025 and combined with TCJA expiring it will be brought in to that as they try to come up with a budget.  Keep in mind that all prior OMB reviews have those expiring so if they are renewed it increases spending/deficits.

I have always included an amount for full-pay insurance in my plan, which may or may not be enough, but this kind of stuff is exactly why.   

I would recommend that anybody that is getting subsidies to look at what the full-pay would be without subsidies, including cost sharing, and see how that fits in your budget.

The hope is that the all the House of Reps who need to get re-elected in two years will push back.

[jim555]

I think ACA and prior existing condition part will largely remain in tact.  Buuutttt.......

I think there is significant risk to the subsidies as they expire in 2025 and combined with TCJA expiring it will be brought in to that as they try to come up with a budget.  Keep in mind that all prior OMB reviews have those expiring so if they are renewed it increases spending/deficits.

I have always included an amount for full-pay insurance in my plan, which may or may not be enough, but this kind of stuff is exactly why.   

I would recommend that anybody that is getting subsidies to look at what the full-pay would be without subsidies, including cost sharing, and see how that fits in your budget.

The hope is that the all the House of Reps who need to get re-elected in two years will push back.

The subsidies do not expire in 2025.  Only the enhanced subsidy formula reverts back to the original formula starting Jan 2026.

[dividendman]

I don't think it gets dismantled. I don't think much will pass the House.

[Turtle]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

Given that this was not a campaign issue this time around, I think the GOP would catch he'll if they tried this, before they accomplished the things they did promise.  That, and pissing of 20M voters wouldn't be smart.

John McCain was the reason they failed at killing it last time.

[tooqk4u22]

I think ACA and prior existing condition part will largely remain in tact.  Buuutttt.......

I think there is significant risk to the subsidies as they expire in 2025 and combined with TCJA expiring it will be brought in to that as they try to come up with a budget.  Keep in mind that all prior OMB reviews have those expiring so if they are renewed it increases spending/deficits.

I have always included an amount for full-pay insurance in my plan, which may or may not be enough, but this kind of stuff is exactly why.   

I would recommend that anybody that is getting subsidies to look at what the full-pay would be without subsidies, including cost sharing, and see how that fits in your budget.

The hope is that the all the House of Reps who need to get re-elected in two years will push back.

The subsidies do not expire in 2025.  Only the enhanced subsidy formula reverts back to the original formula starting Jan 2026.

Got it, thanks.   So if they expire with no other changes or repeal then subsidized premiums probably double but it relative to total premium is still relatively small and highly subsidized (depending on income).

[Scandium]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

Given that this was not a campaign issue this time around, I think the GOP would catch he'll if they tried this, before they accomplished the things they did promise.  That, and pissing of 20M voters wouldn't be smart.

If you need to cut $2T from the budget, getting rid of health care subsidies is a good place to start. Because we know it ain't coming from the defense budget.

That'll leave the ACA without subsidies, which will make it too expensive for many of its enrollees.

s
Everyone, especially their voters, knows that "cutting the budget" is just code speak for cutting money that might benefit brown people. They'll do that and lower taxes for rich/white people and increase the deficit even more.  They don't give a shit about balancing the budget, they just want to slightly code "harming the wrong people" policies.

[dividendman]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

Given that this was not a campaign issue this time around, I think the GOP would catch he'll if they tried this, before they accomplished the things they did promise.  That, and pissing of 20M voters wouldn't be smart.

If you need to cut $2T from the budget, getting rid of health care subsidies is a good place to start. Because we know it ain't coming from the defense budget.

That'll leave the ACA without subsidies, which will make it too expensive for many of its enrollees.

s
Everyone, especially their voters, knows that "cutting the budget" is just code speak for cutting money that might benefit brown people. They'll do that and lower taxes for rich/white people and increase the deficit even more.  They don't give a shit about balancing the budget, they just want to slightly code "harming the wrong people" policies.

If "their voters" know that, how come so many more "brown people" voted for Trump than before? I guess they just like voting for white folks to get more stuff.

[reeshau]

I think ACA and prior existing condition part will largely remain in tact.  Buuutttt.......

I think there is significant risk to the subsidies as they expire in 2025 and combined with TCJA expiring it will be brought in to that as they try to come up with a budget.  Keep in mind that all prior OMB reviews have those expiring so if they are renewed it increases spending/deficits.

I have always included an amount for full-pay insurance in my plan, which may or may not be enough, but this kind of stuff is exactly why.   

I would recommend that anybody that is getting subsidies to look at what the full-pay would be without subsidies, including cost sharing, and see how that fits in your budget.

The hope is that the all the House of Reps who need to get re-elected in two years will push back.

The subsidies do not expire in 2025.  Only the enhanced subsidy formula reverts back to the original formula starting Jan 2026.

Got it, thanks.   So if they expire with no other changes or repeal then subsidized premiums probably double but it relative to total premium is still relatively small and highly subsidized (depending on income).

The biggest thing is the return of the subsidy cliff at 400% of poverty.  So, those living FatFire may indeed need to adjust their plans.

[reeshau]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

Given that this was not a campaign issue this time around, I think the GOP would catch he'll if they tried this, before they accomplished the things they did promise.  That, and pissing of 20M voters wouldn't be smart.

John McCain was the reason they failed at killing it last time.

True,  but they still won't have a supermajority.  And, they only get a limited number of things they can do on reconciliation.  So, does killing the ACA, not even on their platform or stump speeches, move ahead of everything else that is?

[jrhampt]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

Given that this was not a campaign issue this time around, I think the GOP would catch he'll if they tried this, before they accomplished the things they did promise.  That, and pissing of 20M voters wouldn't be smart.

John McCain was the reason they failed at killing it last time.

True,  but they still won't have a supermajority.  And, they only get a limited number of things they can do on reconciliation.  So, does killing the ACA, not even on their platform or stump speeches, move ahead of everything else that is?

IDK, but they got really close last time.  And John McCain is dead now.

[Scandium]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

Given that this was not a campaign issue this time around, I think the GOP would catch he'll if they tried this, before they accomplished the things they did promise.  That, and pissing of 20M voters wouldn't be smart.

If you need to cut $2T from the budget, getting rid of health care subsidies is a good place to start. Because we know it ain't coming from the defense budget.

That'll leave the ACA without subsidies, which will make it too expensive for many of its enrollees.

s
Everyone, especially their voters, knows that "cutting the budget" is just code speak for cutting money that might benefit brown people. They'll do that and lower taxes for rich/white people and increase the deficit even more.  They don't give a shit about balancing the budget, they just want to slightly code "harming the wrong people" policies.

If "their voters" know that, how come so many more "brown people" voted for Trump than before? I guess they just like voting for white folks to get more stuff.

Because he promised to hurt other brown people. This is the endless cycle of "older" immigrants hating on newer immigrants. See; irish, italians, etc

[jim555]

I think ACA and prior existing condition part will largely remain in tact.  Buuutttt.......

I think there is significant risk to the subsidies as they expire in 2025 and combined with TCJA expiring it will be brought in to that as they try to come up with a budget.  Keep in mind that all prior OMB reviews have those expiring so if they are renewed it increases spending/deficits.

I have always included an amount for full-pay insurance in my plan, which may or may not be enough, but this kind of stuff is exactly why.   

I would recommend that anybody that is getting subsidies to look at what the full-pay would be without subsidies, including cost sharing, and see how that fits in your budget.

The hope is that the all the House of Reps who need to get re-elected in two years will push back.

The subsidies do not expire in 2025.  Only the enhanced subsidy formula reverts back to the original formula starting Jan 2026.

Got it, thanks.   So if they expire with no other changes or repeal then subsidized premiums probably double but it relative to total premium is still relatively small and highly subsidized (depending on income).

Inflation Reduction Act Health Insurance Subsidies: What is Their Impact and What Would Happen if They Expire?

https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/

[tooqk4u22]

I think ACA and prior existing condition part will largely remain in tact.  Buuutttt.......

I think there is significant risk to the subsidies as they expire in 2025 and combined with TCJA expiring it will be brought in to that as they try to come up with a budget.  Keep in mind that all prior OMB reviews have those expiring so if they are renewed it increases spending/deficits.

I have always included an amount for full-pay insurance in my plan, which may or may not be enough, but this kind of stuff is exactly why.   

I would recommend that anybody that is getting subsidies to look at what the full-pay would be without subsidies, including cost sharing, and see how that fits in your budget.

The hope is that the all the House of Reps who need to get re-elected in two years will push back.

The subsidies do not expire in 2025.  Only the enhanced subsidy formula reverts back to the original formula starting Jan 2026.

Got it, thanks.   So if they expire with no other changes or repeal then subsidized premiums probably double but it relative to total premium is still relatively small and highly subsidized (depending on income).

Inflation Reduction Act Health Insurance Subsidies: What is Their Impact and What Would Happen if They Expire?

https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/

So per link, avg enrollee contribution would go from $888 to $1593, or roughly double but still not bad if the rest of ACA and subs survive.

[classicrando]

If "their voters" know that, how come so many more "brown people" voted for Trump than before? I guess they just like voting for white folks to get more stuff.

Because the Leopards would never eat MY face.

/s

[mistymoney]

Nobody knows.  The problem is they have no plan to replace it and it is VERY complex.  The ACA is highly ingrained now and you just can't remove it.  They probably nibble around the edges.

seems I heard this about roe v wade....

[sixwings]

Nobody knows.  The problem is they have no plan to replace it and it is VERY complex.  The ACA is highly ingrained now and you just can't remove it.  They probably nibble around the edges.

seems I heard this about roe v wade....

They were McCains surprise vote away from ripping it out with no replacement in 2017(?). There's no McCain this time around.

[elysianfields]

Nobody knows.  The problem is they have no plan to replace it and it is VERY complex.  The ACA is highly ingrained now and you just can't remove it.  They probably nibble around the edges.

Nobody knew that health care could be so complicated.

[chasesfish]

- The ACA gutted its own funding Republican Congress, as part of the TCJA, gutted the ACA’s mechanism / ability to expand the insurer pool via waivers / cancellation of the coverage requirement.  However the ACA guaranteed issuance of coverage, which no politician will reverse.    The number of 20-50yr olds opting out of the insurance pool continue to make this unaffordable.

The penalties did not take effect until 2013, after the 2012 election.   When they did, the list of waivers to the penalties were significant, including "received a past due utility bill", just don't pay your power bill long enough to get a notice then catch up and no penalty. 

There weren't any teeth before 2017.   I'm also completely unsure where the data on "healthcare costs have improved" in the last 14 years.   The profit "margin" cap in the ACA is a preverse incentive for providers and insurers to collude to increase the total billings.

I'm not thrilled about paying almost $12,000 a year for a "healthcare plan" that's basically only bankruptcy insurance from the US medical system.  It's unfortunate that's considered an improvement from pre 2010 healthcare for self employed / retired people.   This was a marginal improvement and not much more.

[Rubyvroom]

I know how Project 2025 recommends they dismantle the ACA, but I don't know how effectively they'll manage to execute that plan.

However, with the likely tax code legislation prioritization, I thought I should point out Project 2025's suggestion to come after employer benefits as well:

"The current tax code has a strong bias that incentivizes business to offer employees more generous benefits and lower wages...the next Administration should set a meaningful cap (no higher than $12,000 per year per full-time equivalent employee-and preferably lower) on untaxed benefits that employers can claim as deductions...The limitation on benefit deductions should not be indexed to increase with inflation. Employers should also be denied deductions for health insurance and other benefits provided to employee dependents if the dependents are aged 23 or older."

-Chapter 22 Department of Treasury, Page 697

[jim555]

- The ACA gutted its own funding Republican Congress, as part of the TCJA, gutted the ACA’s mechanism / ability to expand the insurer pool via waivers / cancellation of the coverage requirement.  However the ACA guaranteed issuance of coverage, which no politician will reverse.    The number of 20-50yr olds opting out of the insurance pool continue to make this unaffordable.

The penalties did not take effect until 2013, after the 2012 election.   When they did, the list of waivers to the penalties were significant, including "received a past due utility bill", just don't pay your power bill long enough to get a notice then catch up and no penalty. 

There weren't any teeth before 2017.   I'm also completely unsure where the data on "healthcare costs have improved" in the last 14 years.   The profit "margin" cap in the ACA is a preverse incentive for providers and insurers to collude to increase the total billings.

I'm not thrilled about paying almost $12,000 a year for a "healthcare plan" that's basically only bankruptcy insurance from the US medical system.  It's unfortunate that's considered an improvement from pre 2010 healthcare for self employed / retired people.   This was a marginal improvement and not much more.

It has been great for me, retired 10 years and haven't paid anything for health coverage.

[chasesfish]

Thus far I've had enough other income sources to not reach the tax credit threashold.   It looks like I will receive tax credits in 2024 unless I hit Roth IRA conversions.

Are you able to find plans with decent coverage?   I'm on a $7,000 / $14,000 deductible bronze plan and that's one of my few options with a nationwide network which we want / need.

[GilesMM]

All we can do is wring our hands and speculate for now. If you need to make contingency plans, assume the worst case scenario.

[caracarn]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

I think this belief is naive at best and grossly misinformed at worst.

In 2016 you still had Republicans in Congress that cared about people.   McCain, Romney, Cheney etc.   Those people are long gone.    They "couldn't get it done" was because of one thumb.  John McCain's.  Had that not happened 50 million people would have been without healthcare.  If they control both chambers and it comes up, it will pass, stop fooling yourself into complacency and be prepared to fight by applying pressure to your local reps if talk of it even starts. 

We've got plenty of people in our family that would immediately lose insurance.  Type 1 diabetics, folks who had cancer before.  I've lived in the world with pre-existing conditions making people uninsurable.  It is not pretty.  And not being able to stay on parent's insurance until 26 would immediately put all six our kids in a budget issue they can't easily adjust to if at all given all the other employement issues in the country and cost of coverage there.

[Omy]

This ^^ is the way I'm looking at it. The health insurance world where individuals couldn't get coverage for pre-existing conditions and there were lifetime caps of $1m coverage were horrible. Both of my siblings would be dead if those limitations had been in place when they were dealing with cancer (twice each).

[reeshau]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

I think this belief is naive at best and grossly misinformed at worst.

In 2016 you still had Republicans in Congress that cared about people.   McCain, Romney, Cheney etc.   Those people are long gone.    They "couldn't get it done" was because of one thumb.  John McCain's.  Had that not happened 50 million people would have been without healthcare.  If they control both chambers and it comes up, it will pass, stop fooling yourself into complacency and be prepared to fight by applying pressure to your local reps if talk of it even starts. 

We've got plenty of people in our family that would immediately lose insurance.  Type 1 diabetics, folks who had cancer before.  I've lived in the world with pre-existing conditions making people uninsurable.  It is not pretty.  And not being able to stay on parent's insurance until 26 would immediately put all six our kids in a budget issue they can't easily adjust to if at all given all the other employement issues in the country and cost of coverage there.

As in many things, history is more complicated than people's memory.  John McCain did cast a dramatic, deciding vote in the Senate.  But it was not against a repeal of the ACA.  It was against the Health Care Freedom Act of 2017, aka the "skinny repeal," that would remove the individual mandate and employer mandate, but nothing else.  Of course, the 115th Congress did eventually change the penalty for non-enrollment to $0, as part of the 2017 tax cut package, effectively enacting the first part, but which in the end did not sink the ACA at all.  There were 66 prior attempts to repeal the ACA more thoroughly,  but none of them reached the point of drama we all remember.

I don't think naively that there aren't Republicans who would like to see the ACA repealed.  But, frankly, it's more popular than Congress.  It's crossover to favorability started, ironically, in 2017.  Also, note in the prior link that 50% of US adults have someone in their household with preexisting conditions.  And polls show a majority, even of Republicans, think it's "very important" that the pre-existing condition provision remain law.

I'm on the ACA, too.  It's not as good as the insurance I had with my employer, but it's an important part of my early retirement.  Should I be wrong, I will definitely speak up and fight for it.   But I am not panicked, at this moment.

[MustacheAndaHalf]

I think it is unlikely, at all.

We already had a republican sweep in 2016, in a campaign where they promised to kill it.  They couldn't get it done, so they killed the nonenrollment penalty, thinking that would destabilize the markets and get insurers to withdraw.  That happened to an extent, but more people are enrolled in ACA now than ever before.

I think this belief is naive at best and grossly misinformed at worst.

In 2016 you still had Republicans in Congress that cared about people.   McCain, Romney, Cheney etc.   Those people are long gone.    They "couldn't get it done" was because of one thumb.  John McCain's.  Had that not happened 50 million people would have been without healthcare.  If they control both chambers and it comes up, it will pass, stop fooling yourself into complacency and be prepared to fight by applying pressure to your local reps if talk of it even starts. 

We've got plenty of people in our family that would immediately lose insurance.  Type 1 diabetics, folks who had cancer before.  I've lived in the world with pre-existing conditions making people uninsurable.  It is not pretty.  And not being able to stay on parent's insurance until 26 would immediately put all six our kids in a budget issue they can't easily adjust to if at all given all the other employement issues in the country and cost of coverage there.

Republicans cannot pass laws with a simple Senate majority - they need at least 60 to override the filibuster.  They can change taxation in a budget, and then "budget reconciliation" measures can pass with a simple majority.  But there are limits on what can happen in a budget bill.  I don't think ACA rule changes would be allowed, only funding changes.  As the earlier poster mentioned, all Republicans could do in 2016 was defund parts of the ACA - that sounds like a budget reconciliation move.

That said you are right that it is still valuable to contact your representatives about the personal impact on people you know if ACA is dismantled.

[caracarn]

Where we appear to differ is I have seen far too many instances both in state legislatures and nationally where what is "popular" does not matter.  We need nothing more than reproductive rights.  No matter how you slice the constituencies every single group was highly 60-65%+ in favor of leaving Roe v. Wade in force yet here we are.  That includes on religious stances, gender, age, stance etc.  Even pro-life voters still wanted it left out of the government's decision and between a woman and her doctor.

So special interests, lobbyists powered by Citizens United and other monied interests will likely overwhelm what the people want and the people will be dealing with it.   I have frankly lost faith in the intelligence of the average voter quite some time ago.  They take no time to learn about what the issues really are and make key decisions to vote on a couple mailers that arrive at home two days before the election or when handed the cheat sheet of how to vote by their party as they walk in the polling place. 

I totally understand there were 66 attempts, and I am saying the makeup of Congress is totally different now and we've seen the abdication of representing your district fall to agreeing to what the small vocal MAGA mob wants because otherwise they primary you and not losing their seat seems more important than representing the people.   We may be past the point of no return already.   When you need to be the most extreme Republican on the ticket to win your primary because of gerrymandering and low information voters just doing what their favorite right wing podcaster tells them to, we are going to keep losing more principled Republicans to extremists.

[Just Joe]

I'm convinced that this GOP obsession with "state's rights" is just another way to divide and conquer. Rather than a national opposition to a Republican law change, now smaller groups of people in dozens of states all need to fight it separately in states with slightly different laws and procedures.

I definitely don't believe "state's rights" have anything to do with state laws better reflecting that state voter's POV on a particular issue. 

[caracarn]

I'm convinced that this GOP obsession with "state's rights" is just another way to divide and conquer. Rather than a national opposition to a Republican law change, now smaller groups of people in dozens of states all need to fight it separately in states with slightly different laws and procedures.

I definitely don't believe "state's rights" have anything to do with state laws better reflecting that state voter's POV on a particular issue.

I agree with you.   The Republicans (and I was happily in their camp for some time) gave up the ghost long ago on that and carrying about America.   All their moves now are about preserving what power they can as a minority party with increasing unpopular fringe policies that obstructs instead of governs.  This is the 1850s all over again.   If you are not familiar with "Letters From An American" I'd encourage you to read this particular post that hits on it a bit https://heathercoxrichardson.substack.com/p/november-3-2024

[reeshau]

There are opinion pieces that will tilt every way.   But I found this piece from Politico to be an interesting exploration of the question: a congressional staffer who helped write the ACA, asking his conservative colleagues (in 2022) what they felt about it, and what they would do about it.

https://www.politico.com/news/magazine/2022/04/26/gop-obamacare-aca-health-care-00027585

TL:DR: it was the mandate that caused a lot of heartache.  With it gone, so was the will to kill it.

Among those quoted in the piece as not supporting a repeal are Susan Collins (who voted with McCain in "the vote") and Chuck Grassley.  They are potentially headed to leading the Senate appropriations and judicial committees in the next Congress.

[Kris]

There are opinion pieces that will tilt every way.   But I found this piece from Politico to be an interesting exploration of the question: a congressional staffer who helped write the ACA, asking his conservative colleagues (in 2022) what they felt about it, and what they would do about it.

https://www.politico.com/news/magazine/2022/04/26/gop-obamacare-aca-health-care-00027585

TL:DR: it was the mandate that caused a lot of heartache.  With it gone, so was the will to kill it.

Among those quoted in the piece as not supporting a repeal are Susan Collins (who voted with McCain in "the vote") and Chuck Grassley.  They are potentially headed to leading the Senate appropriations and judicial committees in the next Congress.

This time around, they’ll be looking to raise as much hate of transgender people as possible in the base, so Republicans will be writing bills to change the ACA so that nothing a trans person could ever be considered gender affirming care will be covered for any reason. So, fuck trans people just for funsies, I guess.

It might not be going away entirely, but never underestimate the Right’s ability to make political hay out of hatred.

[dividendman]

I'm convinced that this GOP obsession with "state's rights" is just another way to divide and conquer. Rather than a national opposition to a Republican law change, now smaller groups of people in dozens of states all need to fight it separately in states with slightly different laws and procedures.

I definitely don't believe "state's rights" have anything to do with state laws better reflecting that state voter's POV on a particular issue.

I agree with you.   The Republicans (and I was happily in their camp for some time) gave up the ghost long ago on that and carrying about America.   All their moves now are about preserving what power they can as a minority party with increasing unpopular fringe policies that obstructs instead of governs.  This is the 1850s all over again.   If you are not familiar with "Letters From An American" I'd encourage you to read this particular post that hits on it a bit https://heathercoxrichardson.substack.com/p/november-3-2024

the "minority party" got more votes in 2022 and 2024 than the Democrats.

[caracarn]

I'm convinced that this GOP obsession with "state's rights" is just another way to divide and conquer. Rather than a national opposition to a Republican law change, now smaller groups of people in dozens of states all need to fight it separately in states with slightly different laws and procedures.

I definitely don't believe "state's rights" have anything to do with state laws better reflecting that state voter's POV on a particular issue.

I agree with you.   The Republicans (and I was happily in their camp for some time) gave up the ghost long ago on that and carrying about America.   All their moves now are about preserving what power they can as a minority party with increasing unpopular fringe policies that obstructs instead of governs.  This is the 1850s all over again.   If you are not familiar with "Letters From An American" I'd encourage you to read this particular post that hits on it a bit https://heathercoxrichardson.substack.com/p/november-3-2024

the "minority party" got more votes in 2022 and 2024 than the Democrats.

They did because we had lower turnout.   Vote counts were not nearly as high.  Those were not Republicans staying home.   You got everyone out of the woodwork.  Republicans have been in the minority in the country for two decades by any study.   This is not an opinion it is backed by data.

[reeshau]

There are opinion pieces that will tilt every way.   But I found this piece from Politico to be an interesting exploration of the question: a congressional staffer who helped write the ACA, asking his conservative colleagues (in 2022) what they felt about it, and what they would do about it.

https://www.politico.com/news/magazine/2022/04/26/gop-obamacare-aca-health-care-00027585

TL:DR: it was the mandate that caused a lot of heartache.  With it gone, so was the will to kill it.

Among those quoted in the piece as not supporting a repeal are Susan Collins (who voted with McCain in "the vote") and Chuck Grassley.  They are potentially headed to leading the Senate appropriations and judicial committees in the next Congress.

This time around, they’ll be looking to raise as much hate of transgender people as possible in the base, so Republicans will be writing bills to change the ACA so that nothing a trans person could ever be considered gender affirming care will be covered for any reason. So, fuck trans people just for funsies, I guess.

It might not be going away entirely, but never underestimate the Right’s ability to make political hay out of hatred.

Yes, changes could be in store.  But the thread title is "dismantled," with images of 2017.  As perverse as it is, and as much as it would need to be corrected later, it's progress to be fighting over it, rather than fighting against it.

[dividendman]

I'm convinced that this GOP obsession with "state's rights" is just another way to divide and conquer. Rather than a national opposition to a Republican law change, now smaller groups of people in dozens of states all need to fight it separately in states with slightly different laws and procedures.

I definitely don't believe "state's rights" have anything to do with state laws better reflecting that state voter's POV on a particular issue.

I agree with you.   The Republicans (and I was happily in their camp for some time) gave up the ghost long ago on that and carrying about America.   All their moves now are about preserving what power they can as a minority party with increasing unpopular fringe policies that obstructs instead of governs.  This is the 1850s all over again.   If you are not familiar with "Letters From An American" I'd encourage you to read this particular post that hits on it a bit https://heathercoxrichardson.substack.com/p/november-3-2024

the "minority party" got more votes in 2022 and 2024 than the Democrats.

They did because we had lower turnout.   Vote counts were not nearly as high.  Those were not Republicans staying home.   You got everyone out of the woodwork.  Republicans have been in the minority in the country for two decades by any study.   This is not an opinion it is backed by data.

So what you're saying is... there are a lot more Democrats, but they didn't vote, at least in the last two elections... so they're the majority party?

[EscapeVelocity2020]

I think of it more as the minority opinion writing the rules, like in the Dobbs Decision.  Trump can say 'I got everyone what they wanted' all day long but public opinion is clearly in favor of the pre-Dobbs era.

ACA repeal will be another instance of 'I got the Federal Government out of the way and sent it back to the states just like everyone wanted'.  But ACA repeal also has the bonus of saving the Federal Government a ton of spending on a benefit most Americans apparently don't really appreciate.

[Just Joe]

I'm convinced that this GOP obsession with "state's rights" is just another way to divide and conquer. Rather than a national opposition to a Republican law change, now smaller groups of people in dozens of states all need to fight it separately in states with slightly different laws and procedures.

I definitely don't believe "state's rights" have anything to do with state laws better reflecting that state voter's POV on a particular issue.

I agree with you.   The Republicans (and I was happily in their camp for some time) gave up the ghost long ago on that and carrying about America.   All their moves now are about preserving what power they can as a minority party with increasing unpopular fringe policies that obstructs instead of governs.  This is the 1850s all over again.   If you are not familiar with "Letters From An American" I'd encourage you to read this particular post that hits on it a bit https://heathercoxrichardson.substack.com/p/november-3-2024

Yes, I learned about that newsletter from this forum, different thread. I don't read it daily but I always enjoy it when I read it.

[Samuel]

I'm convinced that this GOP obsession with "state's rights" is just another way to divide and conquer. Rather than a national opposition to a Republican law change, now smaller groups of people in dozens of states all need to fight it separately in states with slightly different laws and procedures.

I definitely don't believe "state's rights" have anything to do with state laws better reflecting that state voter's POV on a particular issue.

I agree with you.   The Republicans (and I was happily in their camp for some time) gave up the ghost long ago on that and carrying about America.   All their moves now are about preserving what power they can as a minority party with increasing unpopular fringe policies that obstructs instead of governs.  This is the 1850s all over again.   If you are not familiar with "Letters From An American" I'd encourage you to read this particular post that hits on it a bit https://heathercoxrichardson.substack.com/p/november-3-2024

the "minority party" got more votes in 2022 and 2024 than the Democrats.

They did because we had lower turnout.   Vote counts were not nearly as high.  Those were not Republicans staying home.   You got everyone out of the woodwork.  Republicans have been in the minority in the country for two decades by any study.   This is not an opinion it is backed by data.

Per Gallup's long running polling on this D's have typically had an edge over R's in party affiliation in recent decades but this flipped in late 2021.

Going into this election their data had it 48% Republican/Lean Republican vs. 45% Democratic/Lean Democratic.

https://news.gallup.com/poll/651092/2024-election-environment-favorable-gop.aspx