Welcome back to Monday. I’m Dan Diamond, a health reporter here at The Post. And somehow, it’s … April? Count me fooled. Not a subscriber? Sign up here.
The ACA’s seven-year switch
Democrats have been celebrating the Affordable Care Act’s 14th anniversary, touting the law’s successes to hammer Donald Trump. And amid the jubilant Barack Obama posts and videos, I couldn’t stop thinking about the arc of the once-derided “Obamacare.”
For seven years, the law languished in the political wilderness, picked apart by Republicans who nearly repealed it; then the ACA became a political strength for Democrats, who are finally winning elections on it.
Our story this weekend dove into the shifting politics, and how the ACA is on its way to joining Social Security, Medicare and Medicaid as nigh-untouchable social programs. More than 45 million Americans now get health coverage through the ACA’s programs.
“Having seen it full circle now, it’s amazing,” Health and Human Services Secretary Xavier Becerra told me. He was a congressman who voted to pass the ACA; then a California attorney general who fought to defend it from the Trump administration; and now the top heath official in the country, overseeing the ACA’s implementation.
“By the time we voted in 2010 … it had undergone some major beatings, and bad publicity,” Becerra reflected. “So to see it today, at 40 million-plus Americans who now have peace of mind because of the Affordable Care Act, that’s a pretty big deal.”
How the turnaround began: Republicans’ repeal efforts. Polling on the ACA shows a clear inflection point in 2017, as then-President Trump and his congressional allies pushed to overturn it, sparking popular resistance and advocacy.
Some of that new popularity was driven by Democratic politicians, organizing voters against repeal. Democrats also got to experience what Republicans had known for years, with their anti-ACA campaigns: It’s easier to mobilize against something, rather than for it.
Some was fueled by the emergence of advocacy groups such as Protect Our Care, providing long-overdue messaging on the law’s benefits, and finding voters who credited the ACA with helping save their lives.
And some began with the outgoing Obama administration, working to provide cover. Former HHS secretary Sylvia Mathews Burwell told me about her own shuttle diplomacy, the first time she has spoken publicly about trying to get GOP leaders to commit to keeping protections for preexisting conditions.
Democrats also benefited from a favorable — and misleading — analysis from the Congressional Budget Office. The nonpartisan office projected that repealing the law’s individual mandate would be catastrophic, leading to 15 million more uninsured people. After ACA repeal failed, Republicans would separately strike down the mandate in December 2017, with no obvious spike in the number of uninsured Americans.
It all added up to political pain for Republicans, who lost the House in 2018, as novice politicians such as Rep. Andy Kim (D-N.J.) built their campaigns around defending the ACA.
There’s a new political normal now. Nearly 60 percent of Americans have favorable views of the ACA, almost double the law’s 33 percent approval rating in November 2013, according to KFF, a nonpartisan health research organization. And after four years of Trump working to weaken the law, President Biden has moved to strengthen it by broadening subsidies, staffing up navigators and making other investments.
“This is the area of public policy — and I don’t mean to be corny — but it really does make a difference in people’s lives in really fundamental ways. And I think the president understands that,” said Neera Tanden, director of the White House Domestic Policy Council.
Republicans are still critical of the ACA, and the House Republican Study Committee’s recent budget proposal takes aim at the law and other health programs.
But after “repeal Obamacare” pledges helped them win campaigns for nearly a decade, Republicans have struggled to find a new message, said Sherry Glied, a former Obama health official and current dean of New York University’s Robert F. Wagner Graduate School of Public Service, who has studied the current landscape.
“They got burned in 2018, and they know that,” Glied said, urging lawmakers to discuss more insurance reforms. “There are conversations that need to be had around coverage policy. And I think the Republicans are afraid of having them, frankly.”
Joe Grogan, who led the Domestic Policy Council in the Trump White House, countered that Democrats were putting so much focus on health care in 2024 because “Biden doesn’t have a lot to run on.” He added that Democrats had exaggerated threats to the ACA over the years.
“Democrats swore that repealing the individual mandate would be a catastrophe, and the ACA would collapse,” Grogan said. “That didn't happen.”
From our reporters' notebooks
Witty set to testify in the Senate
UnitedHealth is set for its Senate showdown: The Senate Finance Committee is planning to grill UnitedHealth Group CEO Andrew Witty on April 30 as the sole witness, a source familiar confirmed to your Health 202 anchor.
Lawmakers have been upset with the company after a cyberattack on Change Healthcare, a UnitedHealth subsidiary, crippled payments across the U.S. health industry for weeks. For more on the conflict and likely questions for Witty, see my analysis in Health 202 last month. (And credit to Politico, which had the date first.)
Agency alert
FDA issues alert on heart pump associated with 49 deaths
The Food and Drug Administration issued its highest-level alert last month about a heart pump associated with 49 deaths and dozens of serious injuries, our colleague Rachel Roubein reports.
The Impella pumps are tiny devices used to temporarily support a patient’s heart, such as during high-risk procedures or after a severe heart attack. But the federal regulator warned it could cut the wall of the heart’s left ventricle if used incorrectly.
A closer look: Despite the FDA’s classification of its March 21 alert as the “most serious type of recall,” the pumps will remain on the market. Abiomed, the device’s manufacturer, has issued new instructions to physicians on proper usage, including how to carefully position its catheter and use imaging when turning it during procedures.
Johnson & Johnson MedTech, which acquired Abiomed in 2022, said in a statement that the left ventricle cuts are a “rare and known complication during invasive cardiology procedures” and highlighted efforts to reduce the risk. The FDA is working with the company to investigate reports of deaths associated with the pumps.
State scan
Texas appeals court blocks state investigations into gender-affirming care for minors
A Texas appeals court upheld two injunctions in related cases Friday, preventing the state from investigating parents who consent to gender-affirming care for their children.
The rulings deliver a setback to Gov. Greg Abbott (R), who directed the Texas Department of Family Protective Services to investigate reports of transgender minors receiving puberty blockers and other treatments in February 2022. His order cited an opinion from the state’s Republican attorney general that such services are a form of “child abuse.”
In affirming one of the trial court’s injunctions, the Austin-based appeals panel emphasized that plaintiffs in the case — a transgender child, her parents and their provider — would suffer “imminent and irreparable injury” if subject to investigations.
Data point
Medicaid ‘unwinding’ hits one-year mark
Today marks one year since the start of the Medicaid “unwinding,” when a pandemic-era promise that anyone enrolled in the safety-net program could keep their health coverage expired.
After 12 months, states have completed eligibility checks for nearly two-thirds of the record 94 million Americans enrolled in Medicaid and the related Children’s Health Insurance Program last April. So far, 19.2 million have been removed from the rolls, while 40.6 million have had their coverage renewed, according to KFF’s unwinding tracker.
Across the country, 70 percent of disenrollments have been for procedural reasons, such as failing to return paperwork, rather than confirming ineligibility. However, there are significant variations among states.
- Nevada and New Mexico, for example, have a procedural termination rate of 93 percent.
- Maine, at the other end of the spectrum, has dropped 22 percent of its Medicaid beneficiaries for procedural reasons.
Health reads
Sugar rush
Happy April Fools’ Day!
Thanks for reading! See you tomorrow.
