Will Congress Listen? Americans Don’t Want ACA Repealed Without Replacement

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who have health insurance through the ACA—are also voicing surprise and disapproval that the current law might be repealed without a replacement.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.

2017-12-12T15:47:59+00:00 January 13th, 2017|health care policy, Public health|6 Comments
AJN senior editor


  1. Peter M Abraham January 24, 2017 at 1:43 pm

    Naomi, I’m a Registered Nurse. Every provider I know accepts cash. Not every provider I know accepts insurance, and all that do accept insurance only accept the ones they want to accept.

    My wife and I had our health insurance cancelled twice. The first insurance was the one we really liked — the one we were promised by former President Obama and the democrats that we could keep. The second one was from the ACA. We avoided using the ACA-based insurance at all cost because we could not afford the high deductible.

    As I’m in the field, I know it is an outright mistruth to state the ACA holds hospitals and providers accountable; all it has done is turn things upside down in terms of patient experience being a marker creating problems for nurses and doctors alike.

    My hope is that ACA will be replace with a method that truly does increase actual access to health care (which insurance never has done); and if insurance is a part of the picture, it is only a part in so far as covering catastrophic events.

  2. LifeCoachRN, Naomi D. Jones, RN, MS, CRNI January 24, 2017 at 12:36 pm

    Peter are you in the healthcare field? Any physician, lab, hospital or clinic can accept whatever insurances they want. This has always been the case not just ACA. The fact is in order to receive any kind of healthcare you have to either have insurance to defer some of your personal costs or you have to be able to pay for the services received. I don’t know if you’ve looked at any medical bills lately at the cost of medical care. If you don’t have money and you don’t have Insurance you don’t get the care or if you get the care you will owe. People have lost their homes and are under financial burdens because of healthcare that they had to receive. One of the other things under the ACA is it holds hospitals and physicians accountable for the outcomes of the care that they give. They can’t just bill for any services without proving that it was necessary. This is one of the things that will bring the cost of healthcare down eventually . This is not a game, this is about people’s lives! The fact remains Trump has nothing along with the Republicans to replace ACA. Hoping does not pay the bills. All anyone and everyone is asking for is that before you repeal and take away what people have, give me your plan. I don’t think that’s too much to ask !

  3. Peter M Abraham January 24, 2017 at 10:02 am

    Naomi, you are wrong in stating 20 million people now have access to healthcare. All this alleged number represents is the number of insured who MAY have access to health care. Health insurance never has, and never will in a free country, guarantee access to health care where the provider has every right to determine the payment methods they accept. There are providers who DO NOT accept insurance from the ACA! There are facilities who do accept ACA who have providers on board who DO NOT accept ACA-based insurance, and then the patient gets stuck even worse.

    The facts remain. Nancy Pelosi made the infamous comment about having to pass a bill (vs. reading it) to know what’s in it. Former President Obama told the American People “it’s not a tax,” “you can keep your doctor,” “You can keep your health care insurance,” “families will save at least $2,500 per year.”

    I look forward to President Donald Trump and his team creating a system where access to health care is handled by something that works — which isn’t insurance.

  4. LifeCoachRN, Naomi D. Jones, RN, MS, CRNI January 24, 2017 at 12:27 am

    First of all Peter, lets talk about the issues and leave out the name calling because despite all of your ‘liar’ remarks, its clear who is lying. 20 million people now have access to healthcare who had nothing before. Pre existing conditions are now covered and children were able to stay on their parents plan until age 26 where before they were kicked off as early as 18. So lying doesn’t work here. Clearly you must have a plan and didn’t need any of these benefits. That’s great. Look outside of your small circle and see 20 million people didn’t just opt n for something they did not need. Also the republicans voted 60 times to repeal ACA since its approval and yet in all these years they don’t have a replacement? Really? They also don’t care because they and their families have insurance for life and Medicare.
    So before you start talking about liars- lets see if the republicans ever replace healthcare for anyone. And as a nurse who has seen the cost of drugs and the care that people get without insurance, to see people have to make decisions whether they should eat or get medications,…I hope I’m wrong

  5. Debby Renner January 16, 2017 at 11:12 am

    Very well said Peter Abraham!

  6. Peter Abraham January 16, 2017 at 10:02 am

    I’m hoping congress listens and removes the disaster called ACA. 100% partisan, 100% democrat, Nancy Pelosi’s famous statement that it has to be passed, rather than read it, to know what’s in it, along with all of the lies told to us by outgoing President Obama and the Democrats:

    * You can keep your current health care insurance if you like it.
    * You can keep your doctor if you like your doctor.
    * Families will save $2,500 per year.
    * And more.

    I hope that everyone remembers Time Magazine named President Obama “Liar of the Year” for the lies he knowingly told concerning the ACA. [EDITOR’S NOTE: President Obama did not win the liar of the year award from Time magazine; he was awarded the lie of the year award from the website Politifact in 2013, an honor that Donald Trump’s was awarded for his campaign statements in 2015.]

    I hope people remember that health care insurance DOES NOT guarantee access to health care in a free country where providers have every single right to determine the payment methods they accept. And that mandatory insurance ONLY lines the pockets of the insurance companies.

    Government’s involvement in health care should be minimal. They should not be a health care provider.

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