Repeal and replace? The public may not think so

Many aspects of health care reform have been divisive issues for years, but this election cycle once again brought health care to the forefront of Americans’ minds. Some look at the election of Donald Trump as evidence that half the nation is behind his calls to repeal and replace the Affordable Care Act (ACA)—but is this actually true?

A study conducted by The Kaiser Family Foundation following the election shows it’s a little more complicated. Only about a quarter (26 percent) of respondents said they want the law completely repealed and replaced. A whopping 49 percent, on the other hand, want to expand the ACA or keep it in its entirety. While the number of people in favor of total repeal and replace is, unsurprisingly, higher among Trump supporters, even they have scaled back (from 69 percent to 52 percent) after the election concluded.

Additionally, both supporters and detractors seem willing to be swayed based on which parts of the bill are brought up. When those who supported total repeal and replace were asked if they still favored this idea if it meant no guaranteed coverage for pre-existing conditions or 20 million people losing health insurance, their stance softened. When supporters of the Act were asked about rising premiums, roughly one fifth of them were swayed.

When broken into pieces, certain parts of the ACA are looked upon favorably by members of all parties. These include:

  • Allowing children to stay on their parents’ health care until age 26
  • Eliminating out-of-pocket costs for certain preventative services
  • Closing the Medicare prescription drug “doughnut hole”
  • Providing financial help to low- and moderate-income Americans who do not receive insurance through their jobs to help them purchase coverage
  • Giving states the option to expand their Medicaid programs
  • Prohibiting denial of coverage based on a person’s medical coverage

The employer mandate—employers of more than 50 employees must offer insurance or pay a fine—was looked upon unfavorably only by Republicans (making for a total of 60 percent across all parties in favor), while the individual mandate was looked upon unfavorably by everyone except Democrats—only 57 percent of whom favored it. Overall, the individual mandate was viewed unfavorably by 65 percent of all respondents.

While these numbers might sound surprising, the reality of them may not be. Campaign rhetoric tends to be heated and, especially this year, very black and white. Although people like the sound of “completely repealing the ACA,” when faced with the reality of what that means, they may realize that it isn’t as simple, or as beneficial, as they originally thought. And if public opinion supports so many aspects of the ACA, more parts of it could be here to stay than previously believed.

As always, more information is needed before we can make any real assumptions about the future of the Affordable Care Act. Trump’s administration has already begun taking steps toward its campaign promise of repeal and replace with the appointment of Tom Price to Secretary of Health and Human Services, but until a complete bill is proposed, its final shape remains murky.