Former White House deputy assistant talks ACA survival in the Trump era

“I do believe that the ACA will endure; it will survive. But there probably will never be a moment to declare a victory,” explained Jeanne Lambrew, former deputy assistant for health policy to President Obama, in her Nov. 15 talk, “Why the Affordable Care Act Survives and What’s Next.”

In addition to discussing her substantial career in health policy, Lambrew focused on her role coordinating the passage and implementation of the Affordable Care Act.

Since President Trump took office, Congress has made three collective attempts to repeal and replace Obamacare, but the bill has survived.

Lambrew said that she thinks that no matter what efforts Republicans put forth to undermine the Affordable Care Act, they will never completely remove the law from the U.S. health care system.

“Because this law is no longer just a pile of paper, a bill, it really is integrated into the fabric of our health care system, so it becomes much more difficult for Congress to try to make that change,” said Lambrew. “I hope sooner rather than later, we shift this debate back to how rather than whether we can provide affordable, accessible coverage to all Americans.”

Lambrew explained that despite the House bill that repealed and replaced parts of the law in May, Medicare provisions, Medicaid policy, and a majority of the insurance reform of the ACA were left intact.

A similar trend was maintained in the Senate, Lambrew said. The high income taxes that were used to support the law and the premium structure packages of the ACA were left unrepealed.

“Even the big, bad repeal bills maintained large parts of the law, so, no. I don’t think I would ever declare it totally dead,” Lambrew said.

She explained that it was no coincidence that her former administration did not refer to the Affordable Care Act as Obamacare. Instead, opponents of the law used the term to conflate people who were opposed to the president with opposition to the law.

“Certainly President Obama felt responsible for it, and was responsible for it on his watch. However, in his succession he kept a relatively low profile. He wants the law to stand up on its own,” said Lambrew. “It was never about him. It was always about the people who he was trying to help. Our mission was not about legacy or politics, but to improve the U.S. health care system.”

Lambrew and the audience also engaged in a conversation on the role of health care in an increasingly political and polarized world. Lambrew described her struggle to determine where the line should be drawn between public health and respect for religious views.

She explained that the balance between religion and public health is always hard to navigate. There’s no right line, Lambrew said, and that line is being moved continuously. Specifically, she expressed her fear that any employer may now be able to say that they have a moral and religious objection to providing a specific type of health care such as abortion, transgender health services, substance abuse services, or vaccines.