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The ACA Is Working. So Why Repeal It?

Photo of Laura A. Siminoff, Dean of the College of Public Health at Temple UniversityLaura A. Siminoff, Dean of the College of Public Health and Laura H. Carnell Professor of Public Health, says that repealing the Affordable Care Act would have profound consequences for all Americans.

As Congress reconvenes and the presidential inauguration nears, it looks increasingly likely that the Affordable Care Act will soon be weakened, transformed or altogether repealed. But if changes to our healthcare system are now inevitable, complacency shouldn’t be. It is critical for Americans to understand that repealing the ACA would have negative consequences for all of us—because regardless of our political stance, we all need and deserve access to quality, affordable healthcare.

Real improvements to our nation’s healthcare system under the ACA are now in jeopardy, particularly for Americans who have historically had the least access to affordable care. This is apparent in cities like Philadelphia, where hospitals in underserved neighborhoods often serve a crucial role for uninsured and underinsured residents. Under the ACA, hospitals like Temple University’s (recently covered in the New York Times) receive additional Medicaid funding that helps cover the cost of care for individuals with nowhere else to turn.

Philadelphia—the nation’s fifth largest city—has no publicly funded safety-net hospital, so the importance of these funds cannot be overstated. They allow hospitals like ours to serve vulnerable and uninsured patients, and to invest in preventive care that helps people stay healthy and out of the emergency room. This saves dollars and allows people to live better and more productive lives. But repealing the ACA would cast this funding into doubt, endangering the well-being of countless families and communities.

Scrapping the ACA would also bring harsh new realities to rural parts of the country. Many of the more than 20 million people who have signed up for health insurance plans under the ACA live in rural areas where affordable plans were previously hard to find—and where public health epidemics like obesity and opioid addiction are spreading. If Congress votes to repeal this law, millions of people will lose access to the first affordable care they have ever had, adding further obstacles to a brighter future.

The ACA has brought undeniable improvements to our healthcare system. More people are covered by insurance plans than ever before. More are seeking care for health conditions early, rather than waiting until their symptoms worsen and treatment becomes more expensive. This means that the rise of healthcare costs is at last slowing—for patients, for providers, and for the rest of us, too.

We have yet to see a viable alternative to the ACA because, economically, such an alternative does not exist. We cannot keep some parts of the current law (like coverage for pre-existing conditions) while scrapping the rest of it. If we don’t require both the healthy and the sick to carry insurance, we simply cannot have affordable insurance coverage—those are the basic economics of an insurance pool.

Many aspects of our healthcare system are still in dire need of rethinking, but it is unrealistic and counterproductive to blame the ACA for failing to fix all of the long-term problems we face. The ACA has always been a political compromise—it is not perfect, but it is a start on the road to quality, affordable care for all. Rather than standing by in the coming months, we owe it to ourselves to question the logic of dismantling the ACA. Why get rid of a work in progress just because it still needs work?

Visit Dean Siminoff's page to learn more about her work.

Posted:  January 11, 2017