Not Just Another Election Year Blog Series: The ACA and the 2024 Election

Not Just Another Election Year Blog Series: The ACA and the 2024 Election

Not Just Another Election Year Blog Series: The ACA and the 2024 Election

This blog post kicks off a series on health care policy and the 2024 election. Unless you are living under a rock, or in a state of denial, you probably realize there will be an election in 2024.  When many people think of election season, they think about endless campaign ads, an increase in contentious social media posts, and debates that seem more like cage matches than thoughtful discourse. This blog series will cut through the noise of partisan bickering and give you real insights into how health care policy is shaping, and being shaped by, this year’s election.

This blog series starts on the eve of the Iowa Caucuses and the same week the open enrollment period for the Affordable Care Act (ACA) ends for most Americans. This blog post focuses on the ACA and the 2024 election. Specifically, this blog post looks at how the law is being talked about, or not talked about, on the campaign trail and what this all means for the status of the law now and in the future.

Repeal Talks Persist

Even though the ACA became law almost 15 years ago, efforts to repeal the law persist. Republicans initially enjoyed success in campaigning against the law but failed to repeal and replace it once they had control of Congress and the White House. Although we saw the repeal and replace conversation pop up a few times in the last year, it never really broken through as a major talking point among the Republicans who want to move into the White House in 2024.

If Only Because of Trump

Recently the ACA and the 2024 election intersected because of comments made by former President Trump. In November 2023, the former president put the debate over the law back in the headlines by saying he would get rid of the ACA and replace it with “much better health care” if he were to be re-elected in 2024. But restarting the repeal and replace efforts is not as popular as it once was among congressional Republicans. Senate Republican Whip John Thune (R-SD) said, “I’m for lowering costs and making our health care system more efficient, but I’m not sure, speaking in response to Trump’s comments, I’d want to know what the proposal is.” Texas Republican Senator John Cornyn stated, “whether we can build a political consensus for something else or not remains to be seen.” Senator Bill Cassidy (R-LA), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, also expressed a skeptical view on the prospects of repeal saying, “it’s a narrowly divided Congress. It’s unlikely to happen.” We expect the former President to continue speaking out against the law unless he starts to see negative impacts on his poll numbers.

Biden Bets Big

In sharp contrast to calls to repeal and replace the ACA, President Biden is touting his record of protecting and expanding it. The Biden administration eagerly points to the fact that more than 20 million individuals are enrolled in a plan ahead of the January 16 deadline for open enrollment. Additionally, the Biden campaign argues that the ACA would be threatened if former President Trump were to win the election in 2024.

It is not surprising that President Biden talks so much about the ACA given the policies his administration has pursued to help people sign up for coverage and to expand eligibility under the law. Almost immediately upon taking office, President Biden signed an executive order allowing the Secretary of Health and Human Services (HHS) to create a special enrollment period so people would have more time to sign up for coverage because of the COVID-19 pandemic. The order also directed federal agencies to review existing regulations and rules to ensure alignment with administration goals to protect and expand the law. The order also repealed two executive orders from the Trump administration which the Biden administration argued undermined the law. President Biden has also tried to use executive action to end what has been referred to as the ACA’s “Family Glitch.” This refers to the fact that the ACA measures eligibility for premium subsidies on an individual basis and not based on the affordability of plans for family members. On the legislative front, President Biden saw the Inflation Reduction Act (IRA) pass Congress and he signed it into law in August of 2022. This legislation extended subsidies, created under the American Rescue Plan Act, to help individuals pay for ACA coverage through 2025. President Biden is calling for these subsidies to be made permanent. We expect President Biden to continue to look for ways to protect and expand the ACA and for opportunities to promote that work to voters.

Looking Beyond November

How do the efforts of President Biden, former President Trump, and others on the campaign trail impact the ACA’s status. As mentioned above, Congressional Republicans have generally not responded to former President Trump’s call to action on the ACA. But of course, that could change, especially if the former president wins re-election. There are no signs that Democratic members of Congress will back down from their support of the law. So, where does that leave us? As is often the case in Washington, especially during an election year, we will need to wait and see. But you can be sure that how the ACA and the 2024 election interact will be something to watch as we start the new year.

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