Why oppose the affordable care act

In June , the Trump administration issued a brief asking the U. Supreme Court to overturn the ACA. The brief was filed in support of an ongoing challenge to the ACA by a group of Republican attorneys general in California v. Yet Medicare, a mandatory insurance for seniors administered by the federal government since , is overwhelmingly approved by the American public.

The opposition to a government role in health care is based on the fact that that the vast majority of our citizens do not trust their government. Yet in , when the uninsured rate hit an all-time low, only one-quarter of respondents to the Kaiser tracking poll knew that. A little under half thought the rate had remained unchanged, and 21 percent thought the rate had risen to an all-time high.

In a now-famous skit by comedian Jimmy Kimmel, people on the street expressed a strong preference for the Affordable Care Act over Obamacare — unaware that they were the same thing.

Once the ACA became law, basically everything bad that happened in health care was attributed to it. For example, rising prices for prescription drugs has been a problem for years. But the ACA did not seek to address that, except for one provision that sought to facilitate generic copies of some of the most expensive biologic medications.

Also, before the ACA, some insurers stopped offering plans in the individual market, while others raised premiums dramatically and often would not cover care at high-cost providers like teaching hospitals. The ACA did create some losers. Among those hardest hit are people who earn just slightly too much to qualify for federal premium subsidies, particularly early retirees and people in their 50s and early 60s who are self-employed. Both were rejected by more conservative Democrats in the Senate.

One might have imagined a round of conservative applause, but instead Republicans pivoted to attack mode. The issues were the constitutionality of the mandate that people buy insurance or face a penalty, and congressional expansion of state Medicaid coverage for poorer patients.

Another key conservative principle is federalism — to retain a central role for the states. The ACA carved out an important role for the states in expanding the state-administered Medicaid program to provide health care for poor Americans. To achieve universal coverage, the federal government needs to do it alone, with a simple federal entitlement, like Medicare. The ACA case therefore set a strange precedent. The result is a lopsided reading of constitutional authority. The federal government has a weakened power to work with private businesses and with states to achieve universal coverage.

Meanwhile, the federal government has a nearly invincible power to itself tax and spend. The battle was not yet over. In , President Donald Trump and congressional Republicans eliminated the tax penalty for going without insurance.

A judge in Texas then held that in doing so, Congress inadvertently repealed the entire ACA, including its subsidies, protections for preexisting conditions and expansion of Medicaid.