Conservatives Want You to Pay More for the Health Plan You Like

Elizabeth Rich points to a web page for the Affordable Care Act as she helps people sign up for health insurance at Swope Health Services in Kansas City, Missouri, March 31, 2014.

The Affordable Care Act, or ACA, is working: The uninsured rate has fallen dramatically since the law went into effect. Newly released data published in The New England Journal of Medicine show that 10.3 million adults gained coverage during the first open enrollment period. According to a recent Commonwealth Fund survey, 60 percent of those with new coverage said they used their coverage to go to the doctor or hospital or to fill a prescription; 62 percent of those people said they would not have been able to do so without their new coverage. Moreover, of those who were looking for a doctor, two-thirds said they were able to get an appointment within two weeks.

People are happy with their coverage. Overall, 78 percent of those surveyed said they were either somewhat satisfied or very satisfied with their new coverage. This is about the same rate as those reported by both people who were previously insured and by those who newly gained coverage. Even 74 percent of self-identified Republicans reported being satisfied with their coverage.

The ACA has not only led to millions of Americans getting health care coverage, but it has also benefited the country as a whole. Earlier this month, the nonpartisan Congressional Budget Office, or CBO, reported that the ACA is helping slow the growth rate of health care costs, which has positive consequences for the federal budget. It is also helping strengthen the solvency of Medicare.

Yet conservatives are not deterred from their quest to repeal or sabotage the ACA. They continue to find ways to undermine the law, from continuing to push for its full repeal to wanting to take away premium tax credits for people in some states. The latter is making its way through federal court, with conservatives arguing—erroneously—that the law intended for the premium tax credits to be available only in states that established their own marketplaces. Therefore, they argue, people living in the 36 states that have a Federally Facilitated Marketplace, or FFM, should not have access to premium tax credits. This week, a panel of the D.C. Circuit Court of Appeals ruled in favor of this argument, but the Department of Justice is seeking a review from the entire D.C. Circuit Court. On the same day, the Fourth Circuit Court of Appeals reached the opposite conclusion in a similar lawsuit, upholding that the law allows for premium tax credits in every state, regardless of what entity is running the marketplace.

While it is important to note that the D.C. Circuit decision has no practical, immediate effect on consumers—the premium tax credits continue unchanged—the question has been raised as to what would happen if conservatives ultimately won these court battles. The answer is that the cost of health care for working- and middle-class people would increase dramatically.

Just how much of an increase could people see? The Department of Health and Human Services reports that 5.4 million people in FFMs signed up for coverage during the first open enrollment period. Eighty-seven percent of those people picked a plan using federal tax credits, lowering the amount of what they paid for their monthly premium from $346 to $82, on average. Without the tax credits, these people would be paying an average of $264 more per month, a 322 percent increase.

The following chart provides a state breakdown of how much more working- and middle-class people would pay, on average, for premiums for the same coverage without access to premium tax credits. There would be triple-digit increases in all of these states.

Conservatives need to disclose their ultimate goal. Are they really advocating triple-digit premium rate increases for millions of Americans? Or are they just hoping that this will lead to the unraveling of the entire ACA, bringing us back to a time when insurers could deny people coverage because of a pre-existing condition, charge women more, or put limits on the amount of care received? Whatever the reason, the negative effects on working- and middle-class families are the same. Conservatives should think twice about rooting for failure.


Tony Carrk is the Director of the Health Care War Room at the Center for American Progress Action Fund.