Over the last four years, the Trump administration has taken a variety of steps to undermine the Affordable Care Act, outside of legal efforts to tear down the existing health care system altogether. As a political matter, the sabotage campaign hasn't made "Obamacare" any less popular.
Gallup reported last week that Americans' support for the ACA "has increased to a record-tying high of 55% after averaging 51% from 2017 through 2019." This is entirely in line with the latest tracking poll from the Kaiser Family Foundation, which showed nearly identical results.
But as the Associated Press reported yesterday, what matters more than the polls is the policy. And as the open-enrollment period nears its end across the country, many throughout the industry are keeping an eye on the total number of consumers.
A crush of sign-ups expected Tuesday on the last day of open enrollment for HealthCare.gov could help solidify the standing of "Obamacare" as an improbable survivor in the Donald Trump years. In 36 states that use HealthCare.gov, Dec. 15 is deadline day for coverage that starts Jan. 1, while another 14 states and Washington, D.C., have later dates. Analysts and advocates who follow the annual insurance sign-ups say interest has gotten stronger with the coronavirus pandemic gripping the nation.
NBC News had a good report along these lines today, noting many consumers would likely take advantage of coverage opportunities through the Affordable Care Act, if only they knew more about them.
People working to enroll Americans through HealthCare.gov, the federal website for the insurance marketplace, say they're worried that the program's benefits aren't reaching as many people as they could, especially in a pandemic and an economic crisis. That's thanks in part to a 90 percent cut in funding for marketing since President Donald Trump took office and additional cuts to navigator programs, which assist people trying to sign up.
Joshua Peck, co-founder of Get America Covered, an advocacy group that promotes enrollment, told NBC News, "One thing that has been a challenge over the last three years, and again this year, is that awareness about open enrollment remains incredibly low. This year, with a lot of new people in the system, that's likely to be a particularly acute gap."
When looking for explanations as to how and why the nation's uninsured rate climbed during Donald Trump's presidency, even as the ACA continued to exist, this is a good place to start.
But it's also a reminder about the kind of changes that are in store over the next four years.
Legislating on health care over the next couple of years will be extremely difficult, in part because of the incredibly narrow Democratic majority in the U.S. House, and in part because of possible Republican control of the U.S. Senate. But the incoming Biden/Harris administration doesn't need Congress to start making health care coverage options easier and more available to Americans and their families.
I have a hunch they'll be eager to do exactly that.
Postscript: It's worth noting for context that if the conservative-dominated Supreme Court destroys the Affordable Care Act in its entirety -- an explicit goal for Donald Trump -- all of this is moot.