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ACA Deathwatch: The real reason the GOP can’t – and won’t – “Repeal” ACA

For the GOP, the problem with repealing ACA is not practical, legislative, or financial.

It’s psychological.

Humans are hard-wired to hate losing stuff, a principle known as loss aversion. We humans strongly prefer avoiding losses to acquiring gains: We get much more upset if we lose a five dollar bill than happy if we find $5.  

With over 20 million more Americans insured now due to ACA and record enrollment going on now, there are millions of voters who will be enormously upset if they lose their health insurance.

The five states with the most people enrolling for coverage on through Monday were ones Trump won: Florida – 1.3 million plan selections, Texas (776,000), North Carolina (369,000), Georgia (352,000) and Pennsylvania (291,000). (thanks to NYT).

The GOP has boxed itself in, and has an impossible task ahead – how to

Not surprisingly, many Trump backers who gained health insurance under ACA are now scared he’s going to deliver on his promise to kill ACA. And not nervous scared – really, really scared.

This adds a whole new dimension to loss aversion – this isn’t a five dollar bill, this is a new liver, diabetes medications, knee replacement surgery.

There’s no way any ACA “replacement” that doesn’t require coverage of pre-existing conditions, have significant subsidies for the poor and near-poor, and mandate insurance is going to prevent these people from losing coverage. Oh, and do that while reducing medical costs and not increasing the national debt.

That’s why the GOP isn’t going to repeal ACA.

For a very thorough discussion of just how many – and who – stand to lose coverage if the GOP does repeal ACA, there’s no better source than Charles Gaba.

3 thoughts on “ACA Deathwatch: The real reason the GOP can’t – and won’t – “Repeal” ACA”

  1. Hi Joe,

    Another good article – I really enjoy your insight on the ACA. However, it occurs to me that the record enrollment might not be a result of Americans’ broader endorsement of the ACA, but could rather be a result of Americans not willing to pay the financial penalty for not having health insurance?

    If what I suggested above is true, then it might also be fair to say that many Americans are not nervous or scared of “losing” their insurance, but might even be grateful to no longer have to pay the penalty?

    Also, what are your predictions for what will ultimately happen? Do you think that insurance costs will actually decrease? Do you think that coverage for pre-existing conditions will be removed? What about subsidies for the poor? Something will have to give, and your point is well-taken. Everything the Republicans have said they want to do, will ultimately be impossible, so there will need to be some give and take on the subsidies, pre-existing conditions, etc.

    Thanks again for another informative article, and any further insight you might have regarding this topic.

  2. Great morning java reading Joe! I\’ve checked out for the Christmas season but just had to check yours this morning! There is no doubt that this monstrosity of a bill would be repealed and re-written day one as it will take several years to do it – right. During this remarkable season shouldn\’t we celebrate seeing Dems and Reps actually talking and taking some time to work thru this in public view instead of throwing something together quickly and \’find out what is in it\’ afterwards?

    Regarding increased enrollment, record enrollment is great but don\’t we need to know the other side of the equation – at what cost? Do they know the costs while enrolling people – we must do this in our industry (a dying art called underwriting) but I wasn\’t sure why that\’s not included in this article? Earlier this year it was reported than ~80% of enrollees received subsidies and those costs were up by 11% – but has there been a recent update from the CBO on this (I apologize if you\’ve written on this as I could not recall)?

    Also, other than going bare, do Americans have any other choice other than bite the bullet now for the increased premiums and have to pull $$ from another part of their budget?

    Again, great read keeping us up to date on all things managed care – now I really am checking out to get ready for the family invasion (aka Christmas celebration at the Ledbetter\’s).

    1. John
      Cost isn’t in the post because that’s not germane to the issue at hand. Namely loss aversion.
      I suggest you can calculate the cost as well as anyone.
      I don’t know why you see the need for additional time to come up with a replacement bill. The GOP has had seven years to come up with alternatives. Price has a 240 page bill that’s been out for months. Ryan’s done the same. And after the gop’s refusal to work with the Gang of Six and refusal to work with Dems to fix ACA I’m not sure the Dems will now – after all that – believe the GOP has suddenly decided to work in good faith.

      Intransigence worked wonders for the GOP. We may see how it works for Democrats.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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