Wednesday, November 07, 2018

ACA probably saved, along with democracy

Below, the gist of an email I sent to a local advocacy group I'm involved with, the BlueWaveNJ healthcare committee. Links added here.
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The election results are something of a Rorschach test for each of us, but the core fact is Dems taking the House and 6-7 governorships. The House win was not a certain thing by any stretch, -- and it means Republicans can't crush democracy, the rule of law....or the ACA. Or Medicaid. Or, next up, Medicare -- which Republicans still want to privatize. The U.S. healthcare system in all its dysfunctional glory has been spared massive despoilment.

While the fate of ACA rules guaranteeing access to individual market insurance for people with preexisting conditions drew all the passion, the battle over ACA repeal has always been fundamentally a funding battle - mainly over funding for Medicaid, which the Republican repeal bills would have cut by some $800 billion dollars. Overall, in 2017 Republicans tried to cut $1 trillion-plus in federal spending to provide access to affordable insurance, eviscerating ACA marketplace subsidies along with Medicaid. That appears to be off the table.  So do Republican plans to cut even more than that going forward (reflected in the 2019 House budget resolution).

Better yet, 3-5 states will probably expand Medicaid in the next year. Referenda for accepting the ACA Medicaid expansion won in Nebraska, Idaho and Utah. Maine has a Dem governor who will put the expansion that a referendum mandated last year into effect. New Dem governors in Kansas (which almost overrode Gov Brownback's veto to expand) and Wisconsin may well get expansion done.  Enrollment for Virginia's expansion is open. Hundreds of thousands of people are going to gain comprehensive health insurance through Medicaid.  On the down side, Montana voters voted down continuing the expansion there.

Had Democrats not taken the House, ACA repeal and massive cuts to Medicaid would have been likely. Step back: avoiding those catastrophes has been a miracle of sorts.

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