By Corinne McSpedon, AJN senior editor

By Daniel X. O’Neil/via Flickr

Congressional Republicans are moving quickly to repeal the Affordable Care Act (ACA), but have yet to offer a replacement plan or indicate when one might be introduced. The possibility that more than 20 million Americans who gained health insurance through the ACA may lose their coverage is a rising concern among health care providers and patients alike. The ANA detailed its Principles for Health System Transformation in a letter to President-elect Donald Trump last month, advocating for “reforms that would guarantee access to high-quality, affordable health care for all,” and the American Medical Association sent an open letter to members of Congress last week urging them to develop a replacement plan before making any changes to the existing law.

Voters—including Trump supporters who have health insurance through the ACA—are also voicing surprise and disapproval that the current law might be repealed without a replacement. The Kaiser Family Foundation conducted focus groups of working class supporters of Mr. Trump from Ohio, Michigan, and Pennsylvania who have insurance through the ACA marketplaces or Medicaid. The nonprofit organization’s president and chief executive, Drew Altman, detailed the results of the focus groups in an op-ed in the New York Times on January 5. Mr. Altman noted that while participants said they were disappointed in the ACA, they were “afraid they will be unable to afford coverage for themselves and their families” but “have no strong ideological views about repealing and replacing [it], or future directions for health policy.”

Like many Americans, those in the focus groups were most concerned about:

  • out-of-pocket costs from copays, deductibles, and premiums
  • medication prices
  • the costs of out-of-network care and insufficient provider networks
  • understanding their insurance

Yet these issues aren’t at the forefront of congressional Republican discussions, which are focused almost exclusively on repealing the ACA as soon as possible. Few details of a potential replacement plan are available, and what is known is not in line with the concerns expressed by these Trump voters and others. When told of the health reform options Republicans are considering, “including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage—several of these Trump voters recoiled, calling such proposals ‘not insurance at all,’” according to Mr. Altman.

The people in the focus groups also “expressed disbelief” when informed Mr. Trump might be inclined to approve of a plan that contains these elements as well as very high deductibles. Altman said, “they were also worried about what they called ‘chaos’ if there was a gap between repealing and replacing the ACA.”

This last concern is echoed in two recent polls. In an NPR/Ipsos poll conducted January 4–5 of more than 1,000 adults of various political affiliations, only 14% indicated they were in favor of repealing the ACA without a replacement plan in place. Similarly, just 20% of respondents in a Kaiser Family Foundation poll of more than 1,200 Americans conducted December 13–19 said the law should be repealed immediately. They also said that repealing the ACA was less important to them than such issues as reducing their health care and prescription medication costs and addressing the “prescription painkiller addiction epidemic.”

After spending six years introducing legislation to repeal and defund the ACA without coming up with a replacement plan, congressional Republicans and Donald Trump seem to be out of touch with the health needs and concerns of the vast majority of Americans—especially the 20 million who stand to lose their coverage when the ACA is repealed.