Editorial: A lot would be lost in repeal of the Affordable Care Act

By The Herald Editorial Board

With apologies to Joni Mitchell, don’t it always seem to go that you don’t know what you’ve got ‘til it’s gone.

Or, in this case at least, ‘til it’s on the verge of being repealed.

With a matter of weeks before President-elect Donald Trump and the 115th U.S. Congress take office, some Republican voters may be having second thoughts about a complete repeal of the Affordable Care Act.

In October, leading up to the election, 69 percent of Republicans polled by the Kaiser Family Foundation said they supported repeal of the ACA, otherwise known as Obamacare. But a month later — and following victories by Trump and Republicans in Congress who had promised to repeal the ACA but have been hazy about what would replace it — the percentage of Republican voters supporting outright repeal dropped to 52 percent.

Kaiser was careful to point out that the poll numbers for November were only a single data point and could change when the same question is asked again this month. And it also should be noted that most of those changing their mind were not now supporting Obamacare; they just favored scaling it back. In the November poll, 24 percent of GOP voters said they favored scaling back the ACA, compared to 11 percent in October.

Even though half of Trump voters favored repeal, large majorities of those who voted for Trump, Kaiser reported, support many of the ACA’s provisions: 83 percent want adults 26 and younger to be able to stay on their parent’s insurance plans; 75 percent like that it eliminates out-of-pocket costs for preventative services; 72 percent support the health insurance exchanges where insurance plans can be purchased; 68 percent approve of its financial assistance for low- and moderate income families; and 60 percent support the prohibition against insurance companies denying coverage because of a pre-exisiting medical condition. The numbers are even higher when Democratic and independent voters’ preferences are included.

What don’t Republican voters like about the ACA? Only 16 percent approved of the mandate to purchase insurance.

The argument all along has been that the individual mandate to purchase health insurance is what makes all the rest possible, and it was a hallmark of an early version of the proposal supported for a time by Republicans in the Senate and conservative research groups, including the Heritage Foundation and the American Enterprise Institute.

Repealing the ACA without having something that includes much of what most like and already are enjoying through Obamacare — including 20 million Americans who now have health insurance because of the ACA — may prove politically unpopular, something for Congress and our own state Legislature to consider.

Congress and Trump ultimately could kick the problem down to the states. And Washington state should be prepared to take over if that happens.

Washington was one of 14 states that created its own health care exchange, and it could continue to offer the exchange if the ACA is repealed. But a repeal of the ACA by Congress could mean low- and moderate-income families would no longer have the subsidies needed to purchase insurance on the state’s exchange.

Likewise, the state could find itself on the hook for the Medicaid expansion. According to a (Tacoma) News Tribune report last month, about 600,000 Washingtonians gained coverage when the state agreed to expand Medicaid. For now those costs are borne by the federal government, but the state has committed to paying a portion of those costs beginning next year. By 2020, the state will be responsible for 10 percent of the costs of Medicaid coverage.

The repeal of the Affordable Care Act, unless it is replaced with something that offers many of the same provisions, would mean a return to the days when hospital emergency rooms were the default health care coverage for too many and families were forced to put out donation jars at convenience stores to fund their child’s cancer treatments.

There are problems to be addressed in the ACA, including controlling the rise in premium costs, but now that there’s a greater likelihood that it’ll be gone, it’s easier to appreciate what we’ve got.