Last year, when presidential candidate Donald Trump hammered the Affordable Care Act as “a fraud,” “a total disaster,” and “very bad health insurance,” many Americans seemed to agree with him.
Now that President Trump and fellow Republicans are attempting to keep their promise to get rid of the law, voters increasingly seem to be having second thoughts.
True, many still dislike the law known as Obamacare, but as the national conversation swells on the fate of a law that affects millions of people in multifaceted ways — and the issue takes center stage at raucous town hall meetings — it’s increasingly clear that many don’t see the ACA as an either-or proposition.
“At first it was a good deal — that was three or four years ago,” says Mark Bunkosky, 56, an independent contractor in Michigan who buys coverage through one of the law’s online portals. “Every year it’s gone up. From where it started, the premium has doubled, and now my deductible has also doubled. And my income has not doubled.”
Bunkosky, a Republican, views the ACA unfavorably but believes Washington should fix it, not toss it. He supports keeping some of the law’s Medicaid coverage for low-income people and its prohibition on discriminating against those with pre-existing illness.
This week, Trump acknowledged that health care is “so complicated.” So are voter opinions on what to do next with the ACA, which expanded coverage to some 20 million people.
“I didn’t like that it mandated people to carry health insurance. And I thought it was just a lie” when it promised affordability, says Amber Alexander, 27, a Pennsylvania independent whose seasonal income puts her on Medicaid in winter and a commercial plan the rest of the year.
However, she adds, “I don’t think it should be thrown out altogether. There are people that do benefit from it, but there are also a lot of people that get screwed.”
Carol Friendly, 67, is an Oregon Republican who voted for Hillary Clinton for president and favors the Medicaid expansion. She objects to the ACA’s reproductive health coverage, though, saying consumers opposed to birth control and abortion shouldn’t have to pay for them.
On the other hand, she says, “I know it put 22 million [people] in the health care system that weren’t there before. So that’s a plus.”
Mixed signals from Republicans add to the political fog.
For weeks, Trump has been promising — but not yet producing — a blueprint detailing his plan to repeal and replace the ACA with “insurance for everybody.” In his address to Congress on Tuesday, he said a new law “should ensure that Americans with preexisting conditions have access to coverage.”
Meanwhile, a leaked GOP Congressional draft replacement bill would shrink coverage subsidies, and House conservatives complained even those were still too expensive. On Tuesday, congressional Republicans told reporters they were still working on “the best way to build a consensus to pass a bill to gut Obamacare.”
For many helped by the health law, such a prospect has focused minds and aroused fears and may account for its rising popularity, says Simon Haeder, a political science professor and specialist on health policy at West Virginia University.
“Now that we have this whole debate on replacing, repealing, repairing — whatever you want to call it — more and more of this information is coming out on what the ACA does and how it’s benefited people,” he says.
ACA beneficiaries and activists flooded town halls held by Republican congressmen last week, urging them not to repeal the law.
“My story thus far has been [of] one who has benefited from the system,” says Michael Bilodeau, 39, who attended two town halls held by California Republican Rep. Tom McClintock. “We are able to see our local doctor, who we like. And our premiums have been, I would say, stable.”
He co-owns a small business with his wife and is on a plan from Covered California, the state’s online marketplace. He fears a big change if the ACA goes away.
“One of the Republicans’ major arguments is that the ACA brought disruption to people’s health care,” Bilodeau says. “It feels like we’re headed toward another disruption.”
Also, many middle- and lower-income Republicans benefit from the health law’s Medicaid expansion and marketplace subsidies. That’s a political hazard for Republicans who would abolish it, says Mark Peterson, a political science professor at UCLA.
“A lot of that base would be most adversely affected by repealing the ACA and replacing it with something that left enormous holes for the working class,” he says.
And while many national Republican policymakers have excoriated it, the Medicaid expansion is supported by some GOP governors.
Some Republican voters object to the ACA because it’s just so complex.
“It would have been better if the federal government had said, ‘Look, to get these 20 million insured let’s just expand Medicaid nationwide and let’s leave everybody else alone,” says Rickey Mathis, 56, a Georgian who voted for Trump and hasn’t had insurance since the factory employing him closed in 2012. “Why did they have to screw up the whole country’s health insurance?”
Michigan’s Bunkosky urges Republicans to think hard about any Obamacare replacement.
“Everybody’s in a hurry for it, but they need to sit down and do it right,” he says. “Some of it is still a good idea.”
Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.