Skip to main content

“They May Have Bought More Than They Bargained For”: Republicans Thought They Had It Bad Before, But It’s Getting Clearer That It’s Even Worse Than They Thought

By December 18, 2018No Comments

In the last twenty-four hours, it’s become clear that the Texas court decision overturning the Affordable Care Act is an even bigger problem for Republicans than originally reported. It goes beyond even the most outlandish of last year’s repeal bills by striking down some of the law’s most popular provisions, such as the prohibition on denying someone coverage because they’re sick and the requirement that adults under age 26 be allowed to stay on their parents’ plan.

Following Friday’s jarring decision by a conservative federal judge to overturn the Affordable Care Act, Democratic state attorneys general have submitted a request for a stay on the court’s order — ensuring that the Affordable Care Act remains in effect while the case makes it way through the appeals process. Should their request be denied, the American people will suffer, and the American health care system will be upended.



  • 12 million Americans who gained coverage through Medicaid expansion would become uninsured.
  • 8 million low-income residents will lose access to billions of dollars in tax credits.
  • 19 million Medicare Advantage beneficiaries could lose their plans because the ACA replaced the payment system previously in effect.
  • Insurance companies may once again be able to discriminate on the basis of health status by charging higher premiums or denying coverage altogether, jeopardizing the care of more than 130 million Americans with pre-existing conditions.
  • The prohibition of lifetime or annual limits on coverage would disappear.
  • The requirement that children under the age of 26 be allowed to stay on their parents’ coverage would be gone.
  • Insurance companies would no longer have to cover essential health benefits, including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, laboratory services, preventative services and chronic disease management, and pediatric services, including oral and vision care.
  • States may lose their platforms for connecting residents to health care options — state marketplaces, federally facilitated exchanges, and hybrid options that use would disappear.
  • Important initiatives to improve quality of care, reduce cost, and increase innovation would disappear. The Affordable Care Act’s initiatives holding hospitals accountable for quality and safety, allowing providers to receive Medicare payments based on quality and care coordination; and funding efforts to states, public health officials, educational institutions, and medical providers to improve treatment of chronic illnesses, reduce health disparities, improve efficiency and value, and to provide comprehensive care, including preventive care, and mental health and substance use disorder services could fall by the wayside.
  • Uncompensated care costs would increase by $1.1 trillion over the next decade because so many people would lose coverage.
  • And the Prevention and Public Health Fund (PPHF), a new funding stream created by the ACA that has sent over $3.9 billion to states since 2010 ($650 million for fiscal year 2017), would be eliminated.


Kaiser Family Foundation President Drew Altman said:

“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.”

Overturning the Affordable Care Act means overturning its most popular provisions, which are supported by both Democrats and Republicans. According to the Kaiser Family 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.
  • Protecting people with pre-existing conditions: 65% of the public supports this, including 58% of Republicans.

The bottom line from the Kaiser Family Foundation’s Drew Altman: “ [Republicans’] 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.”