2017-05-12 11:55:02
Why Some Can’t Wait for a Repeal of Obamacare

For Linda Dearman, the House vote last week to repeal the Affordable Care Act was a welcome relief.

Ms. Dearman, of Bartlett, Ill., voted for President Trump largely because of his contempt for the federal health law. She and her husband, a partner in an engineering firm, buy their own insurance, but late last year they dropped their $1,100-a-month policy and switched to a bare-bones plan that does not meet the law’s requirements. They are counting that the law will be repealed before they owe a penalty.

“Now it looks like it will be, and we’re thrilled about that,” Ms. Dearman, 54, said. “We are so glad to feel represented for a change.”

The voices of people like the Dearmans helped spawn a political movement after the passage of the health law seven years ago. But unlike the pro-Obamacare forces that have flooded congressional phone lines and town hall meetings, opponents of the health care law have been quieter as Mr. Trump and Republicans in Congress have worked to fulfill their promise to get rid of the law.

Yet even if the law no longer faces the kind of strident grass-roots opposition that helped hand the Republicans the House in 2010 and the Senate in 2014, many who perceive themselves as losers under its policies are still anxiously awaiting its demise.

The challenge for Republicans is to reclaim the narrative, countering the intense resistance to repeal with personal stories of people struggling with high insurance costs, tax penalties and government rules.

Senator Mitch McConnell of Kentucky, the majority leader, invoked those struggles when he sent a Twitter message on Monday: “To those who’ve suffered from the failures of Obamacare: We hear you. Congress is acting.”

The American Action Network, a conservative group, is spending nearly $3 million on new television and digital ads praising the House bill and those who voted for it. The television ads are running on national cable and in 21 congressional districts. Future ads will include testimonials from people “about how devastating the A.C.A. was for them,” said Corry Bliss, the group’s executive director.

They are competing with viral video moments like the emotional appeal to Congress by the comedian Jimmy Kimmel to ensure that seriously ill people like his infant son can get treatment, and the furious response from a town hall audience to the assertion by Representative Raúl R. Labrador, Republican of Idaho, that “nobody dies because they don’t have access to health care.”

House Republicans find themselves on the defensive for passing a bill that would weaken protections for people with pre-existing medical conditions, sharply cut federal Medicaid funding and require many poor and older people to pay a much larger share of their health insurance bill. Yet they are being rooted on by Americans like the Dearmans who expect the Republican legislation to bring them more choices and lower their personal costs.

In some cases, though, their zest for repeal has been tempered by concern or confusion about some specifics of the Republican bill, especially the relaxing of protections for people with pre-existing conditions.

In interviews over the last few days, people who support repealing the Affordable Care Act pointed to their long-simmering resentment of its mandate that most Americans have health insurance or pay a tax penalty. Many also said that they could no longer afford the comprehensive coverage available on the individual market, and that they were eager to once again be allowed to choose skinnier policies without a penalty.

“Now I will no longer be expected to pay twice what I should for a product I don’t need and be treated like a criminal with a fine if I refuse,” said Edward Belanger, 55, a self-employed business appraiser in Dallas. He is an independent who usually votes Republican but last year chose Gary Johnson, the Libertarian candidate, over Mr. Trump.

Like the Dearmans, Mr. Belanger canceled a plan that complies with the Affordable Care Act and bought a short-term policy that does not meet the law’s standards, paying $580 a month for his family of four compared with the nearly $1,200 a month he paid last year. Policies like theirs usually have high deductibles and primarily offer catastrophic coverage for major injuries. Once the policies expire, policyholders must reapply and may be rejected if they are sick.

Last year, the Dearmans paid $1,100 a month for themselves and a college-age son, with a $2,000-per-person deductible. Both they and the Belangers earn too much to receive subsidies under the Affordable Care Act, which limits them to people with incomes up to 400 percent of the poverty level, or $97,200 for a family of four.

Middle-class Americans who feel squeezed by the full cost of insurance under the law are among its fiercest critics, and could in many cases be winners of a sort under the House bill, which would provide subsidies to families that earn far more than the Affordable Care Act’s income limit. They would range from $2,000 a year for people in their 20s to $4,000 for those in their 60s, with a limit of $14,000 per family, gradually phasing down for couples earning more than $150,000. There is no guarantee, however, that deductibles would be smaller under the Republican plan.

Ms. Dearman said she was hesitant to embrace the House plan fully. Since last Thursday’s vote, she had seen anguished posts about it in her Facebook feeds and heard news snippets about how it could hurt older people and those with pre-existing conditions.

“I’ve been listening to some TV here and there and thinking, ‘What am I missing?’” she said. “They were showing protests outside somewhere in Chicago. That’s when I thought, ‘All right, I need to read a little bit more.’”

Others feel the plan does not go far enough. Austin Craig, a commercial video producer in Provo, Utah, said he was frustrated that it would provide premium subsidies to many Americans — though based on age instead of income — and retain many of the insurance regulations in the Affordable Care Act.

“This is not principled reform,” said Mr. Craig, 33, who likened his political philosophies to those of Senator Rand Paul, Republican of Kentucky, who has called the House bill “Obamacare lite.” “It’s just rearranging the government involvement instead of pulling it out.”

Thomas Johnston, a retired factory manager in Marco Island, Fla., said he supported repealing the health care law only out of hope that he could afford health insurance again.

Mr. Johnston, 61, bought coverage through the law’s online marketplaces for several years but did not renew his plan for this year after learning his $640 monthly premium would be rising again. He said he qualified for a subsidy last year under the Affordable Care Act, but owed back all $2,000 of it at tax time. His income ended up being over the $64,000 limit for a household of two once his wife, who is on Medicare, started receiving her pension and he took a part-time job at a miniature golf course.

“It has to be better than what we’ve got now,” Mr. Johnston said of the Republican plan to replace the law. “I have literally no health insurance because I can’t afford it.”

He has not followed the details of the Republican plan, he said; he was not aware, for example, that as someone in his 60s, he would receive a $4,000 annual subsidy under it.

“To be real honest, I wish I understood it a little more,” he said of the bill.

Mr. Belanger said that while the Republican bill would most likely help “people in my situation, who are in the individual marketplace and generally healthy,” it would not address the problems of people with expensive diseases.

“In the end, it’s going to be some sort of government program that takes care of those people,” he said. “If it were up to me, I’d allow people to buy their way into Medicaid. I’d rather be taking care of them through my tax dollars, with all the other taxpayers in the country, than pay twice as much as I should for insurance.”

Katrice MacKay, a homemaker in Provo, expressed revulsion toward the Affordable Care Act, yet said she wanted people with pre-existing conditions to be protected moving forward. She said her family of four was paying $1,000 a month for a high-deductible plan with no subsidy, up from $500 a month before the law took effect.

“The amount we are getting hit, compared to other people who are paying nothing and getting everything covered, doesn’t add up to me,” she said. “I think the divide is too wide.”

Still, Ms. MacKay, who voted for Mr. Trump, added that people with pre-existing conditions deserved to be protected.

“I did have siblings who couldn’t get insurance in the past and that’s just wrong,” she said. “They shouldn’t be dinged more than anyone else.”