Now that a
Texas judge has ruled that the entire Affordable Care Act is unconstitutional —
all because of its individual mandate — Republicans may find themselves wishing
for a different outcome.
The big
picture: There is little hope of a deal with Democrats on health reform
in a divided Congress if the decision is upheld. Democrats will now use the
2020 campaign to paint Republicans as threatening a host of popular provisions
in the ACA. And here’s the kicker: protections for pre-existing conditions, the
provision that played such a big role in the midterms, is not even the most
popular one.
Here are just
some of the more popular provisions that would be eliminated —
in order of their popularity, according to the Kaiser Family Foundation's November tracking
poll:
- Young adults can remain on their parents'
health insurance policies until age 26: 82% of the public supports this,
including 66% of Republicans.
- Subsidies for lower and moderate income
people: 81% support this, including 63% of Republicans.
- Closing the "donut hole" so there's no gap
in Medicare prescription drug coverage: 81% like this, as do 80% of
Republicans.
- Eliminating costs for many
preventive services: 79% support this, as do 68% of Republicans.
- Medicaid expansion: 77% like it, as do
55% of Republicans.
The list goes
on, but notably, further down but still very popular: 65% of the
public supports protecting people with pre-existing conditions, as do 70% of
Democrats, 66% of independents and 58% of Republicans. The fact the
pre-existing conditions does not top the list shows how popular all of the
other provisions are.
The Republican
attorneys general brought their lawsuit in a different political
environment, when Republicans held the House, Senate and the White House. If
that had continued, they could have had reason to hope that a ruling in their
favor, if upheld by higher courts, could have helped them achieve their goal of
repeal and replace legislation.
The bottom
line: Their world has changed politically, with Democrats preparing to
take control of the House next year, and Republicans may have been better off
settling for the repeal of the mandate penalty that Congress already passed.
The mandate was by far the least popular part of the law and gave them
something to crow about. Now, they may have bought more than they bargained
for.
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