Timothy Jost, CNN:
The ACA has also been remarkably successful in achieving its goals. Both the percentage of Americans who are uninsured and the rate of growth in health care spending are at historic lows. Republicans continue to talk repeal, but actual repeal would at this point be disruptive.
One of the great virtues of the ACA is that it has managed to extend coverage significantly without disrupting the three primary forms of coverage enjoyed by most Americans. Nearly half of Americans are insured through their employment, while Medicare and Medicaid each cover another sixth. The ACA has expanded benefits for employed Americans by requiring coverage for preventive services and capping out-of-pocket expenditures. Employer-sponsored enrollment has remained largely stable under the ACA, while Medicare and Medicaid enrollment have grown. Premiums for employer coverage and for Medicare have increased more slowly than in previous years.
Republican reform proposals, on the other hand, take aim squarely at the most widespread forms of coverage. Conservatives have long called for an end to the tax exclusions that have helped to make employer coverage nearly universal in the United States. They would not eliminate them entirely, rather replacing provisions that currently exempt employer-sponsored coverage from income and payroll taxes with capped deductions and exclusions. For many employees this will result immediately in higher taxes or premiums. Moreover, Congress is unlikely to adjust the fixed dollar subsidies to keep pace with health care inflation, so excess cost increases will simply be shifted — dollar for dollar — to employees.