What's behind the healthcare rate hikes and 7 other things Donald won't tell you about the ACA

The Affordable Care Act recently made news for rate increases. Trump and the GOP are trying to use these increases as political weapons
One of the things he doesn’t tell you is that some of these increases could be attributed to the failure of the GOP to expand Medicaid. He also doesn’t tell you that he has no plans to fight rate increases. 
Without further ado, here’s more on this, and some of the other things he’s not telling you about the Affordable Care Act. 
1. Experts warned the states that if they didn’t expand Medicaid coverage, customers could see higher premiums. 
Why? Because hospitals tend to shift the costs of emergency room care to private insurers. In Nebraska in 2014, for example, hospitals provided uncompensated care to 54,000 people who would have qualified for coverage under Medicaid expansion. 
Adrian Sanchez, a spokeman for the Nebraska Hospital Association, said: 
As a result of Nebraska's failure to expand Medicaid, insured Nebraskans are likely to see an increase in health insurance premiums as they continue to cover the uncompensated healthcare costs of the uninsured. 
The Indiana Hospital Association similarly released a report saying individuals would see premiums drop by $241 and families by $691 if Indiana expanded Medicaid and extended coverage to 400,000 residents under the ACA. 
States that refused to expand Medicaid are almost all Republican-led states. 
2015 Medicaid expansion by state.
Where the states stand on Medicaid expansion. 
Business Insider says something similar: 
Many of the states seeing serious increases share similar traits: They have not expanded Medicaid, they have a low number of insurers active in the state, and they have larger rural populations, which are more expensive to cover.
This number includes 12.7 million who have purchased insurance in the marketplace. It also includes those who have gotten insurance through Medicaid expansion and young adults who were able to stay on their parents’ plan.
77 percent of people looking for plans in the marketplace can find a plan for less than $100/month with subsidies. More than 7 in 10 (72 percent) can find a plan for $75/month or less.
MIAMI, FL - NOVEMBER 02:  Martha Lucia (L)  sits with Rudy Figueroa, an insurance agent from Sunshine Life and Health Advisors, as she picks an insurance plan available in the third year of the Affordable Care Act at a store setup in the Mall of the Americas on November 2, 2015 in Miami, Florida. Open Enrollment began yesterday for people to sign up for a 2016 insurance plan through the Affordable Care Act.  (Photo by Joe Raedle/Getty Images)
Martha Lucia (L) sits with Rudy Figueroa, an insurance agent from Sunshine Life and Health Advisors, as she picks an insurance plan at a store setup in the Mall of the Americas on November 2, 2015 in Miami, Florida. 
4. In the initial years of the plan, insurers may build in risk premiums
Once the ACA reforms have been in place and insurers understand the newly covered population, the market should stabilize and these risk premiums should disappear. 
In states that don’t expand Medicaid, however, risk premiums are more likely to persist due to continued uncertainty. 
Tax credits adjust to match changes in a benchmark plan. Here’s an example from the Department of Health and Human Services: 
A 27-year-old with an income of $25,000 a year will on average get a monthly tax credit of $160, a 62 percent increase compared to their tax credit in 2016. As a result, this consumer will pay $142 per month to purchase the benchmark plan in 2017, almost exactly the same as in 2016, when the consumer would have paid $143.
As tax credits adjust to match benchmark premiums, some people who weren’t eligible in 2016 may be eligible for tax credits in 2017. 
Of the 1.3 million people on the exchange who didn’t receive tax credits, it’s estimated that 22 percent could be newly eligible for credits in 2017. 
7. “Repeal and replace” means “Repeal” 
If Republicans wanted to fix the plan, they could easily pass legislative fixes. 
They don’t. 
So they propose that somehow the legislation has to be repealed first in order to be fixed. What they don’t tell you is that they know Congress is completely incapable of passing something new after it’s repealed. 
Repeal and replace = repeal. 
No matter what Donald or Republicans or anyone else for that matter tell you their replacement is, it won’t happen if the ACA is repealed. 
Coda
With the election two weeks away, there’s a lot of hysteria about a lot of things. Everything is being exaggerated to be terrible, horrible, and terribly horribly awful
Healthcare premiums have been rising for decades. This is likely going to continue to be a problem unless we do something. What we do know is that Republicans have no plans to fix it. They only have plans to repeal it. 
If we want to make things better, we should be fighting for a single payer plan: Medicare for everyone. 

David Akadjian is the author of The Little Book of Revolution: A Distributive Strategy for Democracy (ebook now available).