AS candidate Donald Trump hammered the Affordable Care Act last year as “a fraud,” “a total disaster” and “very bad health insurance,” more Americans than not seemed to agree with him.
Now that President Trump and fellow Republicans show signs of keeping their promise to dump the law, many appear to be having second thoughts.
Multiple polls show rising support for the ACA, including two recent ones indicating Americans feel more positively about it than ever. True, many still dislike what’s known as Obamacare. One survey showed 42 percent see it unfavorably while 48 percent viewed it favorably.
But as the national conversation swells on the fate of a law that affects millions of people in multifaceted ways — and the issue takes center stage at raucous town hall meetings — it’s increasingly clear that many Americans don’t see the ACA as an either-or proposition.
“At first it was a good deal — that was three or four years ago,” said Mark Bunkosky, 56, an independent contractor in Michigan who buys coverage through one of the law’s online portals. “Every year it’s gone up. From where it started, the premium has doubled, and now my deductible has also doubled. And my income has not doubled.”
Bunkosky, a Republican, views the ACA unfavorably but believes Washington should fix it, not toss it. He supports keeping some of the law’s Medicaid coverage for low-income people and its prohibition on discriminating against those with preexisting illness.
This week Trump acknowledged that health care is “so complicated.” So are voter opinions on what to do next with the ACA, which expanded coverage to some 20 million.
“I didn’t like that it mandated people to carry health insurance. And I thought it was just a lie” when it promised affordability, said Amber Alexander, 27, a Pennsylvania independent whose seasonal income puts her on Medicaid in winter and a commercial plan the rest of the year.
However, she said, “I don’t think it should be thrown out altogether. There are people that do benefit from it, but there are also a lot of people that get screwed.”
Carol Friendly, 67, is an Oregon Republican who voted for Hillary Clinton for president and favors the health law’s Medicaid expansion, which many Republican policymakers excoriated but has gained support among some GOP governors. She objects to the ACA’s reproductive health coverage, saying consumers opposed to birth control and abortion shouldn’t have to pay for them.
On the other hand, “I know it put 22 million in the health care system that weren’t there before,” she said. “So that’s a plus.”
Adding to the political fog are mixed signals from Republicans.
For weeks, Trump has been promising — but not yet producing — a blueprint detailing his plan to repeal and replace the ACA with “insurance for everybody.” In his Feb. 28 address to Congress, he said a new law “should ensure that Americans with preexisting conditions have access to coverage.”
But a leaked GOP draft replacement in Congress would shrink coverage subsidies, and House conservatives complained even those were still too expensive. Just this week, congressional Republicans told reporters they were still working on “the best way to build a consensus to pass a bill to gut Obamacare.”
For many helped by the health law, such a prospect has focused minds and aroused fears and may account for its rising popularity, said Simon Haeder, a political science professor and specialist on health policy at West Virginia University.
“Now that we have this whole debate on replacing, repealing, repairing — whatever you want to call it — more and more of this information is coming out on what the ACA does and how it’s benefited people,” he said. “Now that’s entering the public conversation.”
ACA beneficiaries and activists flooded town halls held by Republican congressmen during their February recess, urging them not to repeal the law.
“My story thus far has been one who has benefited from the system,” said Michael Bilodeau, 39, who attended two town halls by California Republican Rep. Tom McClintock. “We are able to see our local doctor, who we like. And our premiums have been, I would say, stable.”
He co-owns a small business with his wife and is on a plan from Covered California, the state’s online marketplace.
“One of the Republicans’ major arguments is that the ACA brought disruption to people’s health care,” Bilodeau said. “It feels like we’re headed toward another disruption.”
Many middle- and lower-income Republicans benefit from the health law’s Medicaid expansion and marketplace subsidies. Forty-three percent of Republicans and 57 percent of independents say Medicaid is important to their family, according to the latest tracking poll from the Kaiser Family Foundation. Many who thought Obamacare was only marketplace plans may be realizing Medicaid coverage is also in jeopardy.
That’s a political hazard for Republicans who would abolish it, said Mark Peterson, a political science professor at UCLA.
“A lot of that base would be most adversely affected by repealing the ACA and replacing it with something that left enormous holes for the working class,” he said. Medicaid beneficiaries “begin to recognize how they’re put at risk, and they begin talking to friends and colleagues and it becomes quite real.”
Some Republican voters object to the ACA not because it expanded coverage but because it did so in such a complex way, with sliding subsidies and reliance on private insurers selling expensive plans with narrow doctor networks.
“It would have been better if the federal government had said, look, to get these 20 million insured let’s just expand Medicaid nationwide and let’s leave everybody else alone,” said Rickey Mathis, 56, a Georgian who voted for Trump and hasn’t had insurance since the factory employing him closed in 2012. “Why did they have to screw up the whole country’s health insurance?”
Franchesca Serrano, 31, looked at marketplace plans in Florida, where she lives, but they “really wouldn’t cover anything” because of large deductibles — the care costs that patients pay before insurance kicks in. “Any of the referrals I needed, blood work I needed done, it would have needed to come out-of-pocket — a lot.”
She’s a single mother who voted for Clinton. Her 2-year-old twins are on Medicaid, which she said is “way better than just the Obamacare” sold through the marketplaces.
She’s not expecting any improvements.
“I think once Trumpcare comes out, we’re screwed,” she said.
Michigan’s Bunkosky, a contractor for heating and air conditioning, urged Republicans to think hard about any Obamacare replacement.
“Everybody’s in a hurry for it, but they need to sit down and do it right,” he said. “Some of it is still a good idea. You shouldn’t have to worry about preexisting conditions.”
This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.