For four years, Donald Trump's administration took a variety of steps to undermine the Affordable Care Act. Those efforts mattered -- the U.S. uninsured rate inched higher for the first time since the Bush/Cheney era -- but "Obamacare" survived the sabotage campaign.
And now, in a classic elections-have-consequences dynamic, the ACA is about to get a whole lot stronger.
Almost immediately after taking office, President Joe Biden created a special open-enrollment period, which hundreds of thousands of Americans were eager to take advantage of. Biden and his team also took steps to strengthen the healthcare.gov insurance marketplace, make it easier for people to enroll in Medicaid, and defend the ACA at the Supreme Court.
But perhaps most important is the Democrats' COVID relief package, which, as the New York Times noted today, will "fill the holes in the Affordable Care Act and make health insurance affordable for more than a million middle-class Americans who could not afford insurance under the original law."
The bill, which will most likely go to the House for a final vote on Wednesday, includes a significant, albeit temporary, expansion of subsidies for health insurance purchased under the act. Under the changes, the signature domestic achievement of the Obama administration will reach middle-income families who have been discouraged from buying health plans on the federal marketplace because they come with high premiums and little or no help from the government.
For many American consumers, this will mean a dramatic reduction in health care premiums -- making "Obamacare" more affordable than ever. In fact, for some lower-income consumers, premiums will drop to zero. It's easily the biggest expansion of the ACA system since President Obama first signed the bill into law, 11 years ago this month.
It wasn't long ago that any proposal to expand the Affordable Care Act would've sparked an intense political fight, but in recent weeks, these provisions have gone largely overlooked by the law's far-right critics. That's partly due to the fact that Republicans didn't put up much of a fight on the COVID relief package, investing more time and energy into Dr. Seuss and Potato Head dolls.
But that's only part of the story. As an NBC News report explained last week, "Unlike with other health care reforms, there are few obvious 'losers' beyond fiscal hawks worried about adding to the deficit. The U.S. Chamber of Commerce and top lobbying groups representing insurers, hospitals and doctors have all endorsed the measures, which would pump more money into the system without asking them to cut costs or pay new taxes."
The catch, of course, is that this boost is temporary: there will be lower premiums this year and next, but because of the budget reconciliation process, utilized in order to overcome a Republican filibuster, it became necessary to give these benefits an expiration date.
And that in turn sets the stage for an interesting election-season fight in 2022. Don't be surprised if Democrats tell voters next year that they want to make the insurance subsidies permanent, and the only way to make that happen is to keep Congress in Democrats' hands.
Health care helped propel Democrats to a U.S. House majority in 2018, but it may yet be one of the defining issues in the next midterm cycle, too.