It’s up to us to stop GOP attacks on healthcare access and affordability

These days, everyone has heard of “Obamacare,” the landmark 2010 law that for the first time created consumer protections like no discrimination based on pre-existing conditions and gender, and no annual or lifetime caps on coverage.

The Affordable Care Act (ACA) turns fifteen this week and, despite a rocky start and endless “Repeal and Replace” attacks from Republican opponents in Congress and President Trump, it has persisted and is more popular than ever. While the march towards quality, affordable healthcare for all remains a long one, the political battle to pass the ACA by the narrowest of margins was huge, and we now face another huge fight to maintain the gains we’ve made in healthcare access and equity so that progress isn’t lost. 

Today, 24 million people, a record number, get their coverage from the ACA exchanges. That coverage is more affordable for millions because of enhanced tax credits passed during the Biden era that enabled many more people to get access. More affordable coverage especially helped people in southern states where Republicans refused to expand Medicaid and huge numbers of people remained uninsured as a result. 

In Texas, for instance, ACA coverage more than tripled thanks to the more generous tax credits to buy coverage. 

Here, in North Carolina 1,027,930 persons received health coverage in 2024 through the ACA. But these numbers tell only half the story. Millions of people who have gotten coverage under the ACA didn’t do so through private insurance, but through the law’s Medicaid expansion provisions. After North Carolina finally expanded Medicaid in December 2023, 640,00 more persons have received health insurance coverage thanks to expansion.

I know well what a difference insurance coverage can make. Before the ACA became law, I went almost two years without insurance, and was rushed to the emergency room four times during that period because I couldn’t afford adequate medication for my diabetes. The ACA allowed me to get insured, and I no longer faced those life-threatening emergencies. Many millions of Americans can tell a similar story about the difference the ACA and Medicaid make in their life – like me, helping save it. 

Under the current administration and Republican-controlled Congress, the ACA, including Medicaid coverage, are at risk once again. Republicans in the House have already passed a budget resolution that would drastically cut both Medicaid and the ACA. If the provisions of this resolution become law, they would roll back so much of the progress we’ve made in the past 15 years. 

This resolution does not extend the enhanced premium tax credits that have helped more people get affordable coverage since 2022. These tax credits are set to expire this year. Without their extension, millions of people won’t be able to keep their coverage next year, and millions more will see higher prices for insurance. Research shows that more than five million Americans are likely to lose coverage if Republicans vote to end the enhanced premium tax credits. 

Among this five million-plus people, young adults ages 18-24 are predicted to leave in the highest number, but they won’t be alone. About 1.3 million, or 52% of Black enrollees, and 2.4 million, or 49% of Latino enrollees currently receiving premium tax credits, are also projected to lose coverage. In addition, around 1.7 million people of all ages with chronic healthcare conditions like arthritis, asthma, Cancer, cardiovascular disease, COPD, and diabetes are projected to become uninsured. 

The cost of coverage under the ACA without the enhanced tax credits will also rise for those who are able to keep coverage. Enrollees who qualify for the regular premium tax credits will be forced to pay an average of $1200 more per year, but some enrollees will pay much more.

People who have received coverage from Medicaid expansion under the ACA are facing similar threats as Republicans in the House are already also considering cutting the Medicaid expansion provisions of the ACA. Currently Medicaid expansion covers about 20 million people who otherwise would not be able to get coverage.  nine out of 10 adults in Medicaid work, many in low-wage industries without access to affordable private coverage.

The Republican plan is to use all the money they save from cutting our healthcare under the ACA and Medicaid expansion to pay instead to extend tax breaks for the wealthy and corporations under the Trump tax law, which also expire this year. In this House budget, tax breaks for the top 1% richest households would cost just over one trillion dollars for the first ten years. That’s about the same amount as House Republicans are proposing to cut from Medicaid and from the Supplemental Nutrition Assistance Program (SNAP), which supports many of the same people. 

This means that Republicans, after promising to lower prices and improve the economy for working Americans, are set to do the very opposite: take food and healthcare away from working class families in order to make the richest people even richer.  It’s up to us to stop them.