The Republican Party is back on the attack on Obamacare, and it makes less sense than ever

FILE – Florida Surgeon General Dr. Joseph Ladapo, front left, gestures as he speaks to supporters and members of the media before a bill is signed by the governor. Ron DeSantis, front right, November 18, 2021, in Brandon, Florida. This week, Ladapo asked the state medical board to create new policies that would likely limit gender dysphoria treatments for transgender youth. (AP Photo/Chris OMeara, File)
(Chris OMeara/Associated Press)

The Republican Party is back on the attack on Obamacare, and it makes less sense than ever

Michael Hiltzik

Dec. 5, 2023

Here are a few helpful rules of thumb to know that we’re heading into a major election cycle: (1) Republican candidates are starting to talk about the need to repeal the Affordable Care Act, and (2) none of them are bothering to to say how that will happen. make American health care better.

Certainly, in recent weeks, Donald Trump has said he is “seriously looking at alternatives” to the ACA, claiming that “the cost of Obamacare is out of control, and it is not good health care.”

Ron DeSantis, who is running for second place behind Trump in the Republican Party race

Presidential presidential

nomination in 2024, said Sunday on “Meet the Press” that he was advocating for a plan that “will replace Obamacare, which will lower prices for people so they can afford health care while ensuring people

with will

pre-existing conditions are protected.” He called it “a completely different health care plan.”

The costs of Obamacare are out of control, and besides, it’s not good health care.

Former South Carolina Gov. Nikki Haley, who is seeking to replace DeSantis as an entrant in the GOP race, has faced many questions about the ACA during the campaign. She’s managed to dodge them with word salads about how she wants to “open up the entire health care system, from the insurance companies, to the hospitals, to the doctors’ offices and the drug companies, and make sure we look at every wart and every one of them.”

That might be worth it, if it wasn’t just nonsense. The truth, of course, is that Haley’s Republican colleagues have had every opportunity they needed to do exactly what she claimed to be advocating, and they have done exactly none of it.

To take just one example, in August 2022, legislation allowing Medicare to negotiate the prices of the most commonly prescribed drugs with manufacturers came before the Senate and House of Representatives. How many Republican senators and representatives voted in favor? Exactly zero. It was passed with Democratic votes and signed by President Biden, and is now the law of the land.

A few things are clear about this emerging Republican position on the Affordable Care Act and on American health care in general: They have no idea what to do with it. It doesn’t matter because they have no intention of doing anything. They are just fooling the public.

Coincidentally, the nascent Republican campaign against the Affordable Care Act will face more

headwind headwind

today than in 2017, when a Republican Party repeal effort was derailed by a famous “thumb-down” vote from the late Sen. John McCain (R-Ariz.).

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Since its inception, the program has gained significant popularity. Adult Americans had a positive view of Obamacare by a margin of 59% to 40%, according to a May tracking poll from the Kaiser Family Foundation (KFF).

The program has steadily gained popularity since December 2016, the poll found; 89% of Democrats and 62% of independent voters favored the program, while only 26% of Republicans viewed it favorably as an indication of why Republican candidates have dusted off their attacks.

As is too often the case, DeSantis and Haley’s positions raise a lingering question about Republican politicians: Who do they think they represent?

It can’t be their voters. We know this because participation rates in ACA marketplace plans in Florida and South Carolina are among the highest in the country. Florida’s marketplace enrollment of 3.1 million residents (14.5% of the population) is the largest of any state. It’s almost double that of California, even though it has about half as many residents. South Carolina’s enrollment of 379,000 (about 7.2% of residents) is tied with two other states


in the country.

In addition, both states are among the national leaders in the percentage of their marketplace enrollees who receive federal premium subsidies. Florida ranks second at 97%, behind only Mississippi, and South Carolina ranks 13th at 94%.

Both states also rank among national leaders in the share of their market participants who qualify for additional deductible savings and cost sharing due to their low incomes: Florida ranks fourth, at 62%, and South Carolina ranks fourth place.


tied with California and Indiana at 19th.

That means that

the consequences of

Any attempt to repeal the Affordable Care Act would fall heavily on their own voters, more so than those in most other states. But the carnage would spread across the country.

The Affordable Care Act has been linked to a historic decline in the national uninsured rate, which dropped to 8% in early 2022. The ACA is also associated with a slowdown in the growth rate of health care spending measured in 2021. About 35 million Americans are enrolled in ACA health plans, including 21 million covered by the ACA’s Medicaid expansion in the 40 states that do so have accepted.

Without a replacement health care program that Republicans never proposed, the old system would return in which health plans in the individual market had the authority to deny coverage to people with pre-existing conditions or charge them high premiums.

More than 135 million Americans with pre-existing conditions would be in this situation, while more than 54 million would potentially become uninsurable at any cost. As a reminder, in case you forgot the pre-Obamacare hell that people with medical conditions faced, the Blue Cross of California denial guidelines ran to 25 pages.

In 2001, the Kaiser Family Foundation and Georgetown University conducted a test by applying for coverage from 19 insurers in eight local markets, on behalf of seven hypothetical applicants with health conditions. The test conditions were hay fever, a knee injury, asthma, a previous cancer diagnosis, depression, high blood pressure and HIV.

Each alleged registrant submitted 60 applications. No applicant received 60 clean offer acceptances without premium surcharges or coverage exclusions.

At the time, it was legal for insurers to impose annual or lifetime maximums on benefits. Women, especially those of childbearing age, were routinely charged more than men. Maternity cover was almost unattainable.

If Obamacare were repealed, the 21 million Americans covered by the Medicaid expansion would lose coverage. As many as 2.3 million people under age 26 could be excluded from their parents’ health plans.

To be fair, DeSantis and Haley’s approach to the ACA is consistent with their documented commitment to the health of their state residents, which is essentially nonexistent. Neither state expanded Medicaid, as they could have done under the ACA, with the federal government picking up almost the entire bill.

Obamacare has been an economic boon, but some red states still aren’t getting the message

That makes health care significantly more expensive for the lowest-income voters, and likely explains the higher enrollment in market plans in Florida compared to California, which did expand Medicaid.


DeSantis’ record is especially embarrassing. His hand-picked state surgeon general, Joseph Ladapo, is one of the biggest purveyors of dangerous health care nonsense. Ladapo has promoted the useless COVID-19 ‘treatments’ ivermectin and hydroxychloroquine. He has advised younger Floridians against COVID-19 vaccination, basing his advice on fabricated data.

The prospect that President DeSantis could give this man a federal platform to inject his disinformation into the American healthcare bloodstream is nothing short of terrifying. We can see the potential impact in Florida’s COVID-19 death rates, which are nearly the worst in the country thanks to DeSantis’ policies.

As of March 10 this year, Florida’s rate was 404 per 100,000 residents, the twelfth worst in the country, according to Johns Hopkins University. California’s rate of 256 per 100,000 was the eleventh best.

DeSantis’ peanut gallery defends its reputation by claiming Florida’s demographics are among the most important


The oldest in the US, and since older people are more susceptible to dying from the disease, it is understandable that the overall rate would be high. But that doesn’t work. First, DeSantis always claimed that it was his policy to take special steps to protect Florida’s seniors; it is clear that he failed to do so.

Additionally, three of the four states with older demographics than Florida Maine, New Hampshire, and Vermont have much lower COVID mortality rates; Vermont’s rate is the second-lowest in the country, behind Hawaii. (The outlier is West Virginia.) But they also had stricter anti-COVID policies and, as surgeon general, did not use a walking firehose of disinformation and disinformation about COVID.

If Trump, DeSantis, and Haley gave any thought to America’s healthcare landscape, they would stop talking about repealing and “replacing” the ACA and come up with concrete suggestions on how to improve it. Instead, they wield their attacks on Obamacare as shibboleths.

They’re the easiest way to get the MAGA base excited without actually doing anything. All they have proven is the old adage that talk is cheap.


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