PHILADELPHIA -- No matter which way the election turns out, it will force the Republicans to do something about the Affordable Care Act (ACA), a political strategist said here.
Take, for example, the case in which Trump wins the presidency, Jennings explained at a briefing Wednesday sponsored by Americans United for Change, a liberal lobbying group, in conjunction with the Democratic National Convention.
"When you feel as a Republican that you've been running on 'repeal and replace the Affordable Care Act' for like 6 or 8 years, and your only criticism was, 'I didn't have the person in White House to sign it,' and then you don't do it [when a Republican is elected]? You know, people tell me it's not a big deal -- this is a big deal," said Chris Jennings, former healthcare adviser to presidents Bill Clinton and Barack Obama.
If, on the other hand, Hillary Clinton is elected president, the Republicans will probably decide to drop their efforts to repeal it, figuring that they won't want to fight it for another 4 years while a Democrat remains in the White House, he told MedPage Today.
As for how these same Republicans feel about cutting Medicare and Medicaid, one is different from the other, continued Jennings, who is now a private healthcare consultant.
"They're scared of Medicare. Why? It's all the old white people who are their base, and without Democratic cover they'll be scared ... They don't think that about Medicaid program. We're at a fork in the road, and they're going to say, 'I need to cut this program big time; I need to have big savings.' I'm not just saying that -- they just passed legislation in the reconciliation bill to do just that, a trillion dollars in Medicaid cuts."
Of the 19 states who haven't expanded Medicaid -- "the vast majority of those governors want to expand it; do you know why they can't? They have state legislators controlled by Republicans who will not provide the authority," he continued. "This [election] is not just about the presidency; it's about the House, the Senate, the state legislatures, the governors. This is huge for the Medicaid program."
Ron Pollack, executive director of Families USA, said when it comes to the ACA, its benefits need to be communicated more clearly. He pointed to a June survey by the Kaiser Family Foundation showing that 42% of those polled felt generally favorable toward the ACA while 44% did not. "That doesn't mean the public wants it repealed; the vast majority do not," he said. Indeed, when pollsters asked about whether it should be repealed, 58% said no while 33% said yes -- and of the 58%, half wanted to see it strengthened.
"There is a lesson here for all of us," he said to the ACA supporters in the room. "Leading by [talking about] Obamacare of the ACA doesn't get you very far, but if you start by talking about the things in it -- like its ban on discrimination against patients with preexisting conditions and its provision allowing children to stay on their parents' insurance until age 26 -- "you go off the chart with support."
As with panelists at a different healthcare briefing on Wednesday, speakers at the Americans United for Change event expressed concern about the rising cost of deductibles in private insurance plans. The Department of Health and Human Services "is experimenting with standardized plans that would provide more services [on a] pre-deductible [basis]," Pollack said. "I think this concept is really worth exploring further."
"We do need to ensure that healthcare cost reductions benefit consumers" who enroll in private plans through the ACA's health insurance exchanges, said Neera Tanden, president and CEO of the Center for American Progress, a left-leaning think tank in Washington. "That should be a first goal ... we had a huge amount of savings vis-a-vis the Affordable Care Act if you look at the [Congressional Budget Office's] projections; if you just take a little bit of those savings and put it back into subsidies, you could save a lot of the exchanges and make them far more affordable for people."
In addition, "There are a lot of people concerned about healthcare costs who have no connection to ACA," she continued. "They're in employer-based plans and seeing rising deductions, rising out-of-pocket costs .. There's real concern there. [And] pharmaceutical costs have risen at double-digit inflation rates, and that's where consumers really feel a lot of out-of-pocket costs."
Former Senate Majority Leader and retired senator Tom Daschle (D-S.D.) said maintaining the viability of the ACA's health insurance exchanges was also a concern. "We need to be realistic about marketplace viability," said Daschle, the co-founder of the Bipartisan Policy Center, in Washington. "We have to find ways to bring healthy people into the marketplace."
DNC: Win or Lose, GOP Will Act on Obamacare
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