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Health officials estimate that the Affordable Care Act has provided health insurance for almost 20 million additional people. Getty Images
  • A report states that 8.3 million people signed up for or renewed their Affordable Care Act health insurance plans during the 2020 enrollment period.
  • The enrollment was only about 5 percent less than last year, even with a court ruling last month that struck down the act’s individual mandate requirement.
  • Experts say the enrollment figure shows the popularity of the program, also known as Obamacare.

Most Republicans in Congress hate it. So does President Donald Trump and a lot of Republican governors.

But “Obamacare” refuses to die.

Repeated attempts to kill the Affordable Care Act (ACA), including a court decision last month declaring the program’s individual mandate unconstitutional, haven’t done much to blunt the health insurance program’s enrollment.

A report issued by the U.S. Centers for Medicaid and Medicare Services on Jan. 8 said that 8.3 million people had either signed up for or renewed ACA health plans through the site during the 2020 open enrollment period.

Included in this figure are 2 million first-time enrollees, notes Kurt Mosley, vice president of strategic alliances at Merritt Hawkins healthcare consultants.

“That shows a lot of faith in the program and in what people think they need,” Mosley told Healthline.

The enrollment numbers represented only a 5 percent drop from 2018, when one additional state — Nevada — was participating in the federal insurance exchange established under the ACA.

Nevada has since established its own insurance exchange, joining a dozen other states that have chosen to directly administer their plans. Pennsylvania is expected to be the 14th state to do so next year.

“The ACA marketplace is remarkably stable and resilient despite many policy challenges, including this court ruling,” Rachel Fehr, research assistant at Kaiser’s ACA program, told Healthline.

“Barring any other policy changes, we can expect the market to remain fairly stable. But it’s hard to predict because [the court case] could change everything,” she said.

Fehr adds that most who did drop ACA coverage last year were enrollees who earned too much money to receive tax credits to offset the cost of insurance.

The individual mandate written into the ACA required every person in the United States to either enroll in a health insurance plan or face a financial penalty on their income tax.

Last month, the 5th U.S. Circuit Court of Appeals ruled that the mandate was unconstitutional, finding in favor of a lawsuit brought by a group of Republican state attorney generals and other ACA opponents.

The appeals court subsequently returned the case, Texas v. U.S., to the lower court to determine whether the ACA can stay in effect without the mandate, or if the entire law establishing the healthcare program should be overturned.

The Trump administration has gone on record calling for the entire ACA to be invalidated, although they say the lower court ruling doesn’t need to happen before the November election.

Analyzing the court ruling, the Kaiser Family Foundation concluded that the initial impact of the court ruling has been relatively insignificant.

Insurers raised their rates about 5 percent in response to the loss of the mandate, which was intended to keep younger, healthier people in the insurance pool and thus control overall costs.

However, the report said the consequences would be severe if the courts decide to overturn the ACA — credited with reducing the uninsured population in the United States by nearly 20 million people between 2010 and 2018 — in its entirety.

“While the ACA’s changes to the individual insurance market — including protections for people with pre-existing conditions and premium subsidies for low and modest income people — have been the focus of much policy debate and media coverage, the law made other sweeping changes that impact nearly all Americans,” the Kaiser report states.

“These include the expansion of Medicaid eligibility for low-income adults; required coverage of preventive services with no cost sharing in private insurance, Medicare, and for those enrolled in the Medicaid expansion; new national initiatives to promote public health and quality of care; and a variety of tax increases to finance these changes,” according to the report.

“The ACA has an impact on every American’s healthcare, and overturning it would affect nearly everyone in one way or another,” Fehr added.

Mosley says it’s unlikely that the courts will rule on the case before the 2020 election, which is probably good news for Republicans.

“The ACA has been growing in popularity overall in the last few years,” Fehr said.

The latest tracking poll from the Kaiser Family Foundation found that the healthcare plan retained a 52 percent approval rating in November 2019.

Public approval of specific elements of the ACA are much higher, including the establishment of healthcare marketplaces where consumers can buy insurance, the provision allowing dependent children to stay on parents’ health plans until age 26, and the prohibition on insurers denying coverage to individuals with preexisting conditions.

Moreover, after spiking in the mid-2010s, premiums for ACA insurance plans have recently decreased, and insurers are offering new plans. In some cases, they’re moving into new states to offer coverage, says Fehr.

“Republicans don’t have a plan, so what are they going to replace [the ACA] with?” Mosley asked.

He predicts Obamacare “will survive unless there’s a replacement plan.”

On the other hand, he notes the ACA may also be threatened by Democrats, some of whom are eager to replace Obamacare with a “Medicare for All” plan.

Republican governors are reluctant to endorse Medicare for All, but “we’ve certainly seen more red states addressing Medicaid expansion under the ACA, especially in the past year,” Fehr said.

“It’s sad that this is political, because you don’t get sick based on your political persuasions,” Mosley said.