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Trying to knock off the Affordable Care Act after nine years of trying unsuccessfully is foolish. Trying to do so without any alternative, better or not, is cruel as well as foolish.
The Affordable Care Act, otherwise known popularly as “Obamacare,” has had more than its share of critics who have attacked its approach to health care — a sometimes convoluted mix of private health care plans and public state “exchanges” —as unsustainable, unaffordable, socialism or worse. The public was initially wary of it, with majorities in polls indicating its lack of support.
But a decade later, Obamacare has taken root and 23 million people have found health insurance, and the health care that comes with it. Polls now show widespread support for the law passed under President Obama. And while the law has many limitations and flaws, the public now tells pollsters that the law should be fixed, not repealed. Hundreds of thousands of people continue to sign up for it each year.
The law is not perfect at the edges. Americans who don’t earn enough can’t qualify for an ACA plan even though they may not qualify for Medicaid. That leaves a gap in coverage. Americans who earn too much don’t qualify for the premium subsidies in ACA plans, leaving them having to pay more than they can afford to get health care. That creates another gap.
The law wasn’t even crafted to cover everybody. It doesn’t affect the majority of Americans who have health insurance through their employment. The really poor families with children are covered under Medicaid, and the seniors 65 years and older are covered under Medicare.
But where the ACA did focus its attention, the law earned Americans’ gratitude. The state expansion of Medicaid, originally a mandate but now optional for states, extended affordable health insurance to the working poor who previously earned too much to get help. Now they can in states that embraced the federal dollars the law offers. North Carolina, unfortunately, is not yet one of those states.
Under the ACA, what’s covered is generally the same in all plans. The premiums on the health care exchanges vary according to how much a person is willing to pay upfront for care. Some plans charge almost nothing in premiums but have really high deductibles and out-of-pocket expenses. The higher the premium, the lower deductibles and out-of-pocket expenses become. There are many levels of coverage and the customers choose what coverage they want.
Other features of the ACA, such as digitizing medical records and increasing communication among providers, have had a positive effect on health care. But the real, deep virtue of the ACA is that it protects people who are chronically ill, with pre-existing conditions or disabled from being denied insurance or having insurance at unaffordable rates. For them, the ACA has literally been a lifesaver.
I saw this problem firsthand. I am a medical mess, beginning from my youth with a hip disease and acquiring other problems as I grow old. I could not buy a health insurance policy on my own at any price. Now I can.
Before the ACA, insurance companies could cancel policies out from under people who became ill with fatal illnesses like cancer. Now they can’t.
Republican conservatives who liked or profited from the old system have never embraced health care reform. They refused to participate in the passage of the ACA, even though the bill contained many conservative ideas such as individual mandates. From its passage a decade ago, Republican politicians have tried their best to “repeal and replace” Obamacare.
They couldn’t do it, even when they had the power, because Republicans could not come up with an adequate replacement. They had no better ideas and every Republican alternative one way or another has made health insurance worse or unavailable for millions of Americans. So the ACA survived Congress and, several times, the Supreme Court.
President Trump, who vowed to replace Obamacare with something better, has done everything he can to weaken or destroy the law on his own. He has downplayed its availability, tried to weaken its protections and embraced the Republican efforts in Congress to replace the law even when it became obvious they had nothing better to offer.
Two weeks ago, the same time the Mueller report was finished, the Trump administration joined a federal lawsuit against the ACA by telling a Texas federal judge, a Republican, that he was right to declare the whole law unconstitutional. The Justice Department, ordered by Trump, is opposing the appeal of that judge’s decision. It is trying to kill in court the law it couldn’t kill in Congress.
The court fight likely won’t succeed, for many reasons. But the fact Trump has attempted to kill the law is spiteful and futile, and the fact he has tried to do so without any pretense of something to replace it is despicable. If he succeeds, he will have done nothing but deny lifesaving health care to millions of people who had it. And Republicans in Congress are saying they have nothing to offer as a replacement, or the ability and desire even to pass one.
Trump’s sabotage and rejection of Obamacare with nothing to replace it is cruel and heartless beyond belief. Nothing good will come out of it, and to think otherwise is fantasy.
Ken Ripley is a resident of Spring Hope and The Enterprise’s editor and publisher emeritus.