Repealing the Affordable Care Act, also known as Obamacare, has stirred up a hornet’s nest among American citizens.

With Republicans in charge of both the U.S. House and Senate and President Donald Trump solidly behind the goal, Democrats and health care advocates have energized to let their voices be heard.

Recently, Colorado U.S. Rep. Mike Coffman, R-Aurora, tried to quell or answer some of that criticism and concern by talking about the type of health care plan he would support in an opinion column on his website.

Metro State University Associate Professor of Political Science Rob Preuhs said Coffman has done well in the eyes of his constituents with moderate positions on issues like immigration.

Not so much on health care, he said.

Coffman took much criticism and made national headlines when he allegedly left a town hall meeting in Aurora six minutes early while many vocal supporters of Obamacare wanted to let him know their thoughts about maintaining the health care program.

Obamacare problem areas need fixing

In his opinion column, Coffman wrote about his experience as a state legislator in 1994, when he sponsored a health insurance reform measure that would have, among other things, provided a “guaranteed issue, meaning that insurance carriers had to cover those with preexisting conditions and could not rate anyone differently based on their health status. The bill spread the cost of doing this through a technique known as ‘adjusted community rating,’ and the legislation prohibited pricing discrimination based on gender.”

“Unfortunately, I was not able to fend off an amendment that exempted the individual health insurance market from the landmark consumer protections provided for in my legislation, but I was at least able to advance these protections for the small employers and the legislation was the first major attempt to reform the health care insurance system in Colorado,” Coffman added. Eventually, the bill was signed into law by then-Gov. Roy Romer.

Coffman added Obamacare’s principal tool for expanding health care has broadened Medicaid to cover able-bodied working people, without dependent children, and by increasing the income eligibility up to 138 percent of the federal poverty level.

He said that was done “at an enormous cost to the taxpayers,” but that otherwise, Obamacare had failed to deliver on its promises to lower costs and to expand private insurance coverage. Coffman pointed to health insurance exchanges, which have seen sharp rate hikes and a lack of participation by more than a handful – or even a single – health insurance company.

Coffman wrote that his plan “to address the inevitable failure of the ACA” in Congress would reform the Medicaid program by giving states more flexibility to design their own systems to improve outcomes and contain cost. He would also cap Medicaid expansion to those now enrolled and allow them to stay on it, as long as they continue to meet current eligibility requirements.

Coffman would eliminate the employer mandate, which he said only applies to businesses of 50 or more employees, “while most of the problems associated with access to employer-based health insurance are found in smaller businesses which have avoided the mandate by not adding jobs.” Coffman said he favored allowing small business to band together to purchase their health insurance so they can get the same discounts as large businesses.

Coffman also favored eliminating the individual mandate.

“In too many cases, it’s cheaper to pay the penalty and buy insurance only when it’s needed, thereby ‘gaming’ the system and pushing up rates for everyone else. Replace this with a tighter requirement to maintain continuous coverage in order to retain eligibility for all the consumer protections (i.e. preexisting conditions) contained in the ACA,” he wrote.

Coffman would also include incentives to purchase health insurance by giving people the same tax deductability as businesses. Coffman would favor helping low-income people with refundable tax credits paid directly for the insurance plan of their choice. And Coffman wants to see higher contribution limits for health saving accounts.

He said he would support maintaining the consumer protections in Obamacare, including requiring insurance carriers to cover preexisting conditions, prohibiting lifetime caps, ensuring no price discrimination on the basis of gender and allowing dependents to stay on their parents’ policies until age 26.

“Finally and perhaps most importantly, I will not vote to repeal any part of the ACA without a concurrent replacement,” Coffman concluded.

“Repeal and replace may be the more palatable approach to his constituents,” Preuhs said, “so he can argue he’s taking the practical position and here’s a better plan we can put in place.”

As with all contentious issues, there are political ramifications and consequences to taking a stance, Preuhs noted. Such as how action on health care reform might affect Coffman’s reelection chances in 2018.

“A lot of that would depend on how immediate a new plan can be implemented,” Preuhs said, so those covered under Obamacare remain covered, and don’t have to pay significantly more.

Coffman likely wants to make the case he will support a reasoned replacement, and if it doesn’t go through, it’s not his fault, Preuhs stated.

“I think ultimately, he’ll vote with the Republicans, then we’ll see how it all plays out with cost and access helping to decide how well he’ll do in his reelection, which right now looks fairly solid,” Preuhs added.