As ACA Under Threat, Dawning Awareness of a Law’s Many Provisions

by matsuyuki/via Flickr

Nurses reflect the American population’s variety, and this means that many nurses support the Affordable Care Act (ACA) and many would like it repealed, whatever the replacement might be.

Like many Americans, nurses may have a broad ideological or analytical perspective on the pros and cons of the ACA or other health policy issues. Or they may choose for or against complex legislation on the basis of a single issue—like abortion funding, or insurance access for a husband or daughter with a preexisting condition, or whether they believe staffing issues can be blamed on their hospital administration or an ACA provision.

But it’s been my experience as an editor at AJN and a citizen that many people don’t really know that the ACA has multiple provisions that address quality and access issues at every level of health care.

The futures of these provisions are all in question as the Trump administration and a Republican-led Congress prepare to hack away at the ACA without a clear replacement plan.

With a kind of pre-obituary fervor, the media is beginning to pay attention to the changes the ACA brought about now that many may soon disappear—so, for seemingly the first time, are many Democratic politicians, who it’s now clear did very little to sell the ACA to their constituents. With that in mind, might it be time to just quietly stop calling the ACA “Obamacare”? If nearly half of the electorate voted for someone else, why agree to nickname an already controversial law by using one candidate’s name? Not only that, but the nickname doesn’t say anything about what kind of law the ACA really is.

Below find links to recent coverage focusing on important ACA provisions at risk plus some related issues to watch as the ACA repeal process takes shape.

  1. What replacement plan? While repeal measures are already underway in Congress, there’s still no clear agreement among Republicans on what an ACA replacement plan could look like. The ACA, flawed as it is by compromise, took years to hammer out. While President Trump is demanding quick action on a replacement, Republicans seem just as likely to do their best to ensure that the negative effects of any immediate repeal legislation don’t begun to be felt until at least the midterm elections.
  2. CBO: Huge drop in insured predicted. Republican repeal maneuvering is taking place against the backdrop of a new Congressional Budget Office report that predicts 18 million Americans would lose health insurance in the first year the ACA was repealed. The numbers go up from there.
  3. HHS nominee: conflicts of interest. Department of Health and Human Services nominee Rep. Tom Price, who has in the past advocated replacing Medicare with a voucher system for the elderly, among other health care policies, continues to face serious ethics accusations about conflicts of interest over his investments in health care stock. This, however, may not stand in his way, given current Republican majorities in the Senate and House.
  4. Effects of repeal on employer-sponsored coverage. Do you get free preventive care with your employer-sponsored health insurance? Do you have an annual out-of-pocket cap on covered expenses? Did you get a job recently and find you had no waiting period to join a plan? These and other protections exist because of the ACA, and they are all in danger.
  5. Other potentially disappearing protections: Before the ACA, you could have been denied new insurance coverage on the open market because you were taking any one of a long list of common medications for arthritis, diabetes, mental illness, cancer, HIV/AIDS, and heart disease? Have a look at Table 3 in this Kaiser Family Foundation report.

While the ACA story seems to be developing very fast, this may only be an illusion. We’ll soon know more.




Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Carol Miller January 23, 2017 at 7:43 am

    Thank you for pointing out that all health care professionals should be using the “professional” label for the ACA rather than the political label. Many Americans think the ACA and Obamacare are two different programs! Also, nurses can use our professional expertise to point out the provisions within the ACA have reduced costs and improved care, for example, by increasing coordination of care and reducing hospital-acquired infections and pressure ulcers. We need to make sure that the “baby is not thrown out with the bath water”!

  2. Jacob Molyneux January 20, 2017 at 10:58 am

    Peter, I’m sorry you and your wife lost your plans and it’s good to know you’re going to be getting on a new plan through an employer. Taxes did not go up because of the Affordable Care Act for most Americans. Health spending began to slow, though continued to increase too fast due to the rising costs of drugs, widespead chronic illness, and many other factors. Budgetary effects of regulating insurance agencies, restructuring Medicare reimbursement to include quality measures, and expanding Medicaid accessibility in some states continue to be intensely debated. Whatever the case, the largely unregulated health insurance system that existed before the ACA was imposing higher and higher premiums and transfering ever more costs to consumers while engaging in many unfair practices that the ACA sought to address. We are now likely to have a chance to see what happens when we go back to that system, roll back Medicaid access and cut numerous public health programs such as drug treatment and mental health services, convert Medicare to a voucher system. Then I suppose we can revisit all this! Best of luck. -Jacob

  3. Peter M Abraham January 20, 2017 at 10:29 am

    RE: “There were 20 million people who didn’t have any insurance before the ACA who now have it.”

    Jacob, as I shared, in a free country insurance does not and never did guarantee access to health care. Insurance is not the answer to improving access to health care in a free country where providers have every single right in the entire universe to determine what payment methods they accept.

    My wife and I had a good plan through Geisinger purchased independently of an employer; that’s the first one we lost. The insurance we just lost was through the ACA. We are temporarily on a plan through Christian Health Ministries until I’m my new employer’s plan.

    That stated, I cannot state enough that insurance isn’t the best vehicle for access to health care. We need to find a way where insurance is only used for catastrophic events.

    Jacob, if you reviewed how much money went into the first few years of the ACA from the year the bill was crafted out to no more than five years (and this was taxpayer money), we could have invested $1 to $3 million in healthcare savings accounts for every single U.S. legal citizen (men, women, and children). All health care providers accept cash, and insurance could be used for catastrophes. Add in that for those that believe in wealth redistribution (I personally do not), then real wealth redistribution could have taken place with the extremely rich helping to fund the extremely poor’s HSA’s that were being emptied due to health care needs being resolved over time.

  4. Jacob Molyneux January 20, 2017 at 10:19 am

    We all agree we can do better. The law needed a lot more work, collaboratively. But that was never on the table with the divided Congress. But it’s just not enough to keep saying that people lost their insurance under the ACA. There were 20 million people who didn’t have any insurance before the ACA who now have it. High deductibles are a huge problem, and were becoming so before the ACA. Would a single payer solution that cuts out the insurance companies be better? Many prosperous countries and their people think so, but America doesn’t seem ready to embrace this option, nor especially do member of Congress. Out of curiosity, what insurance plan did you have before you got insurance through the ACA? Was it through a former job, or simply purchased on the open market?

    Regarding the protections the post focuses on. I currently have insurance through my employer. But years ago, before the ACA, when I tried to buy insurance on the open market with a preexisting condition (type 1 diabetes), the only insurance I could buy was one that cost over a thousand dollars a month and provided only catastrophic coverage and little else of worth. While now I’d have to shop for a plan on the insurance exchanges, and no doubt find them more than I could easily afford, with too limited a network of doctors, at least I’d be much better off than previously. For people with more serious conditions, this has been a life-saver.

    So the basic idea here, as stated in the post, is that we all see the ACA through different lenses, and all have something to like and something to complain about. But the many problems it set out to address will remain, and none of the current Republican plans seem interested in addressing them. It’s just not helpful to keep making this about Nancy Pelosi as the new enemy #1.

  5. Peter M Abraham January 20, 2017 at 9:39 am

    There are Registered Nurses like myself who do not and have not supported the (un)affordable care act. People should also remember the following:

    1) A 100% partisan, democrat run bill where Nancy Pelosi made the infamous comment about passing the bill in order to know what’s in it vs. allowing proper time to read it.
    2) The many lies:

    * You can keep your current health insurance plan if you like it.
    * You can keep your doctor if you like your doctor
    * Families will save an average of $2,500 or more per year.
    * It’s not a tax!

    My wife and I lost our health care insurance twice due to the (un)affordable care act. The second time was with a ACA plan that we were afraid to even use due to the extremely high deductibles we could not afford.

    Working in healthcare, I’ve had doctors share with me the horror stories of ACA in terms of just going to the emergency room where many hospitals contract out the ER doctors. Those ER doctors may not accept ACA-based insurance, and then all of a sudden the actual costs go through the roof because while the hospital the patient went to at the ER was covered, the doctor wasn’t. How was the patient to know?

    And in terms of doctors and other facilities, in a free country, every provider has every single right to determine what payment methods they accept. That means insurance is NEVER guaranteed access to health care.

    We need to replace the ACA. We need a system that DOES NOT involve insurance companies except for catastrophic situations. We can do better.

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