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Most readers do not favor ACA repeal

With the backing of President-elect Donald Trump, congressional Republicans plan to make repeal of the Affordable Care Act one of their first actions in 2017. They contend it has driven up premium costs while undermining care.

But a majority of respondents to this week’s RBJ Daily Report Snap Poll favor keeping the ACA, also known as Obamacare. More than half—52 percent—say the law should remain with changes to improve it. Five percent said the law should be left alone.

Of the rest, one-third say the law should be repealed and replaced with legislation that keeps some ACA provisions. And 11 percent say it should be repealed entirely.

Signed into law in March 2010, the ACA is perhaps the signature legislative achievement of Barack Obama’s presidency. The White House says under the law the number of uninsured individuals in the United States has dropped by more than 40 percent—from 49 million to 29 million in 2015. The administration also says the ACA has improved coverage and lowered costs for Americans who had insurance before the law was passed.

The ACA has a broad range of provisions. Trump and congressional Republicans have signaled they favor retaining some of these provisions in new health care legislation.

Among the most significant ones are requirements that individuals who can afford it obtain basic health insurance coverage or pay a fee and that businesses with 50 or more FTE employees offer affordable medical coverage to their workers. By 52 percent to 48 percent, respondents favored keeping these provisions.

In a Snap Poll conducted two years ago, 43 percent of respondents said the ACA should be repealed. And three years ago, a slight majority favored repeal.

Nearly 900 respondents participated in this week’s poll, which was conducted Dec. 5 and 6.

Regarding the Affordable Care Act, which of the following do your favor?

The law should remain with changes to improve it:  52%

The law should be repealed and replaced with legislation that keeps some ACA provisions:  33%

The law should be repealed entirely:  11%

The law should be left alone:  5%

Of the following ACA provisions, which do you want Congress to keep? The one that…

Allows children to stay on their parents’ plan until they turn 26 years old:    Yes: 86%    No: 14%

Bars annual and lifetime dollar limits on most benefits     Yes: 77%    No: 23%

Establishes minimum standards for health insurance plans including free preventive care     Yes: 77%    No: 23%

Helps states fund expansion of Medicaid programs     Yes: 59%    No: 41%

Prohibits denial of insurance coverage due to pre-existing conditions     Yes: 88%    No: 12%

Provides a tax credit to help small firms and nonprofits offer health insurance     Yes: 78%    No: 22%

Provides subsidies to help low-income individuals and families obtain coverage     Yes: 77%    No: 23%

Requires businesses with 50 or more FTE employees to offer affordable medical coverage to their workers (employer mandate)      Yes: 52%    No: 48%

Requires individuals who can afford it to obtain basic health insurance coverage or pay a fee (individual mandate)     Yes: 52%    No: 48%

COMMENTS:
The United States is the only industrialized nation without a single-payer health insurance. Surely we can take the best of what other nations are doing and adapt it to our situation.
—Carlos Mercado

The ACA is more of a tax bill than a health care bill, and IRS revenues are now at record levels. I suggest they run a parallel system that opens up competitive, across-state competition while they reconstruct and replace the ACA and give users the option to change at any time.
—Hugh Rundle, Brighton

Talk of repealing the Affordable Care Act must stop. Speaking from the trenches, I have seen firsthand how the unanticipated diagnosis of a life-threatening disease can devastate financial stability even in the most stable of individuals and families. There is room for improvement in all things, but the Affordable Care Act offers a sound platform from which to begin.
—Holly Anderson, executive director, Breast Cancer Coalition

The ACA should absolutely be repealed, but only to be replaced with a single-payer government system—aka, Medicare for all—just the same way every other major Western democracy does it. There is absolutely no reason for the U.S. to subject its citizens to being the lone holdout for commercialized health care.
—Matthew D. Wilson

If the purpose is to make medical coverage available to all citizens, keep rising costs controlled and not bankrupt the country, then it must be mandatory that ALL citizens have more skin in the game, including the 27 million young people who do not believe they need it, as they surely will be enrolled as they get older and require health care. The risk must be balanced and shared by all.
—J.A. DePaolis, Penfield

The so-called “Affordable Care Act” never was. The law was rammed down Americans’ throats by the Democrats who were not truthful about what it really was. As the ACA rules slowly “kicked in” over the last four years, Americans realized they had been sold snake oil. The ACA was really just part of the Democrat plan toward socialized health care. Another step in the Democrats marching the U.S. toward socialism. And everyone who knows history knows that socialism fails wherever it’s tried! The result was an angry voter backlash that has removed Democrats from power. Maybe they will get it now, but I doubt it!
—George Thomas, Ogden

Any administration is going to have a hard time keeping the positive changes (i.e., pre-existing conditions) without facing the cost increases that we have seen. There are most likely improvements that can be made, but admittedly I do not know what they are. I believe we need to give the ACA more time so that it has a fair chance to truly succeed or fail.
—David Wyman

There are many good parts of Obamacare that need to continue. Unfortunately, Obamacare is not cost effective, includes additional taxes and has several mandates that have nothing to do with health care. The transition needs to be slow and methodical to get us the best health insurance at an affordable price.
—Mike Hogan, Information Packaging Corp.

Universal health care is what we need. The ACA was at least a first step. We are the only industrialized republic without health care for all. This is not only wrong and immoral, it is backward thinking. As a sole proprietor, my premiums were reduced from $900 per month to $450 under the ACA. I don’t understand why we have become such a mean and nasty society who supposedly believes in God. Life is not business.
—Eve Elzenga, Eve Elzenga Design

It’s not as broke as Republicans want everyone to believe. And, as we have seen, neither Republicans nor the president-elect, have revealed what the “something” better they want to replace the ACA with will be. Most likely Republicans will vote to repeal but also to delay the actual killing of the act until, at least, after the mid-term elections, so that they try to avoid the likely voter backlash when people who voted for them realize that they will be losing this benefit. Then they will let the ACA die a messy death, and we will be back where we were 20 years ago.
—Ron Brooks, Rochester Software Associates

Modeled on the Heritage Foundation’s plan and Gov. Mitt Romney’s experience in Massachusetts, the ACA insures that every private insurance company can get a windfall of customers and taxpayer support for the salaries and bonuses of its executives; drug companies and care providers have their revenues protected; and, incidentally, more citizens get health care. Win-win, no?
—Michael Leach, city of Rochester

The program needs to be looked at holistically, taking out partisanship, to address the unintended consequences. The Republicans have had more than five years to come up with an alternative plan—or amendments to improve it. But they haven’t offered any solutions—because the Affordable Care Act was THEIR plan; they just opposed it because Obama put it forward in an effort to get closer to the goal of insuring more people. It’s a shame they wasted so much time opposing rather than doing the work of the people.
—Judy Palmieri

This law needs tweaks and adjustments to help make this program fiscally sound and helps to define what are reasonable expectations. With like all things, there isn’t an infinite pool of resources; we need to better manage levels of care and service. This will lead to a two-tiered level of care, but it already is here today. The complexity of health care is not something that could be fixed with the way ACA was handled. Now is the time for hearings and identify what is working and what parts have failed. This is a long-term process and not learning from this would be greater tragedy.
—Daniel Herpst

Costs, higher than in comparable countries with full coverage, continue to rise. If we don’t come up with a workable private/public hybrid, we will eventually wind up with single-payer. Since that would facilitate worker mobility and level the playing field between companies that might not be all bad.
—Bill Murphy

The basic premise of any insurance is simple; abuse it and the costs go up. The insurer will never lose money, at least permanently anyway. The rates will always make it up the following year. Take people that can’t pay, add them to the risk pool, and someone is going to pay to make it up. Many low-income recipients thought they were getting “free Obamacare.” Only they come to find out they got free insurance with a high deductible attached. However, they don’t care about a deductible; no intention whatsoever of paying a deductible. So, the provider gets stiffed. My insurance has gone up 20 percent minimally year over year. I’d rather the government started a “gofundme.com” page for uninsured. Warren Buffet and Mark Cuban and most of Hollywood have plenty to contribute to their fellow Clinton supporters and should do so of their own accord.
—Doug Strang

A law that was passed without reading by our representatives (Pelosi’s “Has to be passed before we can know what’s in it”) and required the bribing of two Democrat senators (no Republican votes) makes it suspect from the start. When our president lies about the cost and the ability to keep our plans and doctors and the main architect calls us stupid to fall for it, something smells. Compound the snarky adoption with the tremendous increases in premiums, deductibles and the withdrawal of several major health agencies and insurance companies and you’ve got a problem child that needs to be repealed keeping only a couple of the provisions such as preexisting conditions and lifetime total expense. Most of the increased coverage came through Medicaid in any event, which was available for the most part without this abomination. Correct me if I’m wrong, but I don’t remember people lying in the streets dying, before the ACA. Somehow, people were cared for through emergency care or other.
—Art Elting, Palmyra

The present system works well for its intended purpose (getting more people insured, and making health insurance more affordable and less likely to be a cause for bankruptcy or death). It works poorly at holding down costs (though better than the system we had before it as is evidenced by less than 15 percent year-over-year increases in health insurance rates. The system should be changed to allow a basic level of care, similar to Medicare or a bronze plan, that is provided by the government, and all other care is supplemental to that care. Better regulation and monitoring of the generation of costs should be put in place including limiting insurance company profits, limiting price gouging on MRRs and prescriptions. The system needs to incorporate more cost controls to keep costs down, and prevent insurance companies from gouging subscribers. The solution to higher costs needs to not be tossing those who are chronically ill or underinsured under the bus.
—Lee Drake, CEO, OS-Cubed Inc.

Obamacare did a lot of good in many ways especially in allowing people to purchase health care if they had a preexisting condition. Elimination of the waiting period is great. Mandate higher percent of premium going to your benefits is good. What hasn’t happened is exposure of the costs of your care. These costs should be easy to find and compare. They are not. There should be standardized billing forms so people understand what they are being charged for. Electronic records should work. They don’t work. Strong doesn’t share records with Regional Health, and vise versa. The government should be taking an active role in questioning the costs of drugs, procedures, hospital costs. The cost of medical care continues to climb without restraint. HSA accounts should be available to all people, not just those with high-deductible plans. People who chose to purchase a co-pay plan should not be penalized with any kind of “Cadillac” tax. Otherwise you are forcing people into a generic high-deductible plan. People should always have the right to purchase the plan of their choosing. They know their health needs. New York State requires the health care companies to pay them a fee for doing business in our state. That could be eliminated, or reduced. There are many fingers in the health care pie and the people have no choice but to pay the amounts that they are billed.
—Jennifer Apetz

Repeal all of it and start over. If our economy is going to flourish while bringing on new, additional, full-time employees in a new economic era, let’s keep them from being choked by the ACA. This includes staying on your parents’ policy until age 26. That should be only if the dependents are still in school at least part-time. And as far as pre-existing, it’s ludicrous to let somebody who has never bought insurance before or in a long time to take advantage of this rule, after they realize they are ill and need treatment. That’s the same as your house being on fire and then giving an insurance broker a call to say I want property insurance effective immediately on my house. That’s not the way insurance works. Prior to the ACA, New York already allowed a 63-day lapse in insurance before somebody could be denied for a pre-existing condition. If you have a preexisting condition and have not bought insurance, then there should be a six-month waiting period before the insurance company needs to cover you. Everybody needs to have some skin in the game! When trying to enact the ACA, the statistics showed the high number of people, especially singles making $50,000 or more a year, but choosing not to buy any health insurance. Free country, right! Pay now or pay later. The onus of this decision should be on them, not the rest of us. I’m in health care because I am passionate about helping people who are ill, but also believe that everyone needs to plan on how to help themselves. There are extenuating circumstances that need to be considered of course, but not 45 million of them.
—B. Moser, Canandaigua

For more comments, go to rbjdaily.com.  To participate in the weekly RBJ Snap Poll, sign up for the Daily Report at staging.rbj.net/dailyreport.

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