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Opinion When Republicans rant about ‘socialism,’ remember the Affordable Care Act

Patrice Michaels of Chicago holds a sign in support of the Affordable Care Act in D.C. in 2017. (Bill O'Leary/The Washington Post)
4 min

One of the greatest government success stories in a generation rarely gets much attention. That is the story of the Affordable Care Act.

The Centers for Medicare and Medicaid Services recently reported a “nearly 50% increase in of since President Biden took office.” In addition, “3.6 million people signed up for health care coverage on the Marketplaces for the first time this year.” Altogether, that resulted in a record-breaking 16.3 million people who selected a plan on the ACA marketplaces during the most recent open enrollment period (Nov. 1 to Jan. 15).

CMS also reported that families who purchased insurance in the marketplace saved an average of $800 in premiums in 2022. More than 90 percent of purchasers had choices from three or more providers.

The administration also has consistently strengthened the ACA in recent years. The American Rescue Plan Act expanded and extended ACA premium support, which the Inflation Reduction Act further extended through 2025.

Biden also eliminated the ACA’s “family glitch,” which based an employee’s eligibility for ACA subsidies on his or her individual rate, even if that person was paying for far more expensive family coverage. That left many families paying exorbitant rates to cover their entire household. Claire Heyison of the Center on Budget and Policy Priorities explained that when the administration’s fix to the family glitch went into effect at the end of 2022, millions of people gained eligibility to buy ACA coverage. Almost half of them were in “families of low-income workers (those earning between 100-250 percent of the federal poverty level, or between $28,000-$70,000 a year for a family of four).”

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In the midterms, almost no Republican — other than Sen. Ron Johnson of Wisconsin — talked about repealing the ACA. That might be because the ACA is widely used in red states. Nine of the 10 states with the highest enrollment rates are led by Republicans. In other words, red states are getting a ride on the federal program their political leaders have long lambasted.

All of this amounts to a historic achievement. Not only did the ACA survive multiple attempts by Republicans to repeal the law and reduce outreach, but it also managed to drive down uninsured rate to a record low of 8 percent last year. That’s in large part because of the Biden administration’s competent management of the program and extension of subsidies over united GOP opposition.

The next time Republicans rant about “socialism,” Democrats should remind them and all Americans about the Affordable Care Act. For years, Republicans denounced the law as “socialist,” yet red-state Americans have been using it at higher rates than blue-state residents. Watch red-state Americans similarly benefit from other government programs that Republican politicians whine about, such as government price controls on prescription drugs and subsidies to help transition to green energy.

Indeed, Democrats should highlight their successes where Republicans have fought against expanding access to health care. Florida, for example, has refused to expand Medicaid under the ACA, leading to its 12 percent uninsured rate.

And that’s about to get even worse: Once the federal government’s covid-19 national emergency ends, so too will pandemic-era policies designed to keep people enrolled in Medicaid continuously. So unless governors act, more people will lose Medicaid coverage. While other governors are scrambling to minimize coverage losses, Florida’s Ron DeSantis has a plan that could kick as many as 1.75 million residents off Medicaid. No wonder DeSantis wants to talk about “wokeism”; his actual record on issues people care most about is putrid.

The lesson of the ACA is clear: With competent leaders, government policies can help Americans. As Republicans vote against these measures and scream “socialism!” — all while claiming the banner of economic populism — Democrats would do well to remind the country which party actually helps ordinary people.