The Affordable Care Act is a sloppily written and overly complex piece of legislation. Five years after passage, slightly more Americans disapprove of the ACA than approve (47 percent approve; 48 percent don’t), according to Gallup.

Nonetheless, the law has gradually become part of the fabric of life. Earlier this month, the Obama administration announced that it has succeeded in pushing the number of uninsured consumers below 10 percent.

As the Associated Press story in the Journal Star earlier this month asserted, the number of people who signed up for insurance under the law underscores how difficult it will be for Republicans to wipe it off the books.

If Republicans are to succeed in repealing the law, they’re going to have to develop a consensus on what should replace it.

In Nebraska, the percentage of residents without health insurance is about right at the national average at 10 percent, according to this year’s Gallup-Healthways Well-Being Index. That’s down from about 14.5 percent in 2013.

Among the states, Rhode Island has the lowest percentage of uninsured residents at 2.7 percent. Texas has the highest percentage at 20.8 percent. Among nearby states, Iowa is the lowest at 5 percent. South Dakota posted an uninsured rate of 7.2 percent. Kansas was 11.3 percent, and Wyoming was 18.2 percent.

One reason that Nebraska compares favorably with other states is that it has one of the nation’s lowest unemployment rates.

It’s worth pointing out, however, that Nebraska would compare even more favorably if state lawmakers had expanded Medicaid coverage.

Among nearby states, only Iowa has expanded Medicaid, under an alternative plan approved by the Obama administration. It had a 9.7 percent uninsured rate in 2013.

Various Republicans have suggested replacement plans for the Affordable Care Act, including a detailed plan drawn up Sen. Ben Sasse which has received favorable reviews in some quarters.

Republican presidential candidates also have released proposals. Wisconsin Gov. Scott Walker, for example, put out a plan last week that he said would mean private health insurance for 6 million Americans. Florida Sen. Marco Rubio also has released a plan.

But in order for a Republican president to replace the Affordable Care Act, he’s going to have to find a majority in Congress, where Republicans have been able to proceed no further than symbolic votes to repeal the law. Congressional Republicans would also have to confront the analysis by the Congressional Budget Office that simply repealing the law would add to the deficit.

This all suggests that Republicans may never succeed in wiping the law off the books. A more achievable and worthwhile goal would be to begin improving it.

-- Lincoln Journal Star, another Lee Enterprises newspaper


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