Affordable Care Act: Should it be dismantled?

The 360 is a feature designed to show you diverse perspectives on the day’s top stories.

Speed read

What’s happening?: The Trump administration has doubled down on its position against the Affordable Care Act, the signature law of Barack Obama’s presidency, saying the entire statute (not just parts of it, as it previously stated) should be repealed. In an appeals court filing, the Justice Department sided with a recent ruling by a federal judge in Texas that found that the Affordable Care Act violates the U.S. Constitution.

Why it’s sparking debate: Democrats are outraged and charge that the move would strip millions of Americans of access to affordable health care. House Speaker Nancy Pelosi called Trump’s maneuver an “all-out war on the health care of the American people.” Some Republican leaders were baffled as to why the president would purposefully shift national attention from his Mueller probe “victory lap” to a topic that has historically been a strong campaign issue for Democrats — and they are incensed at Trump’s acting chief of staff Mick Mulvaney who swayed the president in this direction.

What’s next: Texas Judge Reed O’Connor’s ruling is being appealed and will likely end up in the Supreme Court, which could position the issue to play a central role in the 2020 presidential campaigns.

The president declared that the Republican Party will now be the “party of health care” and would have a plan “far better than Obamacare,” but in reality the GOP does not yet have a substitute plan that could readily replace the Affordable Care Act.

Democrats are rolling out a new plan to attempt to strengthen parts of the Affordable Care Act. The bill would expand premium tax credits, increasing subsidies for lower-income people and extending eligibility to people with higher incomes who are currently locked out. Nearly 11.4 million have signed up for Obama-era health plans this year, a slight dip from 2018.

Repealing the Affordable Care Act entirely would risk leaving more than 20 million Americans uninsured, including 12 million covered through Medicaid expansion and 11 million who use subsidized private health insurance and state-run insurance markets. Also at risk: coverage for preexisting conditions, young adults covered on family plans, caps to limits on insurance payments and funding to fight opioid addiction.

Perspectives

The administration’s move is a gift to Democrats.

“When you’re the opposition party, much of what the administration does will make you angry, even horrified, but you often struggle to make the public share your outrage. Yet every once in a while, the administration will do something so obviously awful that you can only see it as a political gift. That’s what the Trump administration just decided to do. Why would the administration do something that is both so substantively horrifying and so politically bonkers? I have a theory, one rooted in President Trump’s unusual approach to both ideology and politics.” — Paul Waldman, Washington Post

Trump’s position on the issue is politically baffling.

“Now that the legal cloud over his head has lifted somewhat, President Donald Trump has decided to double down on his most unpopular policy issue. He even tweeted that the Republican Party would become the party of health care. … You might think that an unpopular president heading into a re-election year would try to emphasize the good things he can take credit for (such as the economy, the tax cut, the trade deals), rather than remind voters of what they don’t like. But Trump has always rejected the conventional political wisdom.” — Rex Nutting, MarketWatch

“After O’Connor’s ruling, Trump praised the decision, saying that with Obamacare apparently gone, he wants “a STRONG law that provides GREAT healthcare and protects pre-existing conditions.” This is precisely the assertion that Trump made during the 2017 effort to overhaul Obamacare. But, at that point, despite controlling both the House and the Senate, Republicans couldn’t come up with a solution that could be passed into law. A law that provides great coverage and protects those with preexisting conditions would be very popular. The problem is that crafting such a law is far harder than it seems, and Trump has already shown he can’t get it done.” — Philip Bump, Washington Post

Remember what it was like before Obamacare?

“People hated the health care system: Before the Affordable Care Act’s arrival, a vast majority of Americans wanted health care and insurance reform, including 82 percent in one 2008 poll. Why? By 2008, health care costs were skyrocketing and insurance plans covered less. …
Women paid more: Women buying insurance on the individual market before Obamacare were often charged more than men — a practice known as ‘gender rating.’ Obamacare made that illegal.” — Editorial board, Charlotte Observer

“I believe there would be an uprising if people knew this means that insurers can go back to denying coverage for pre-existing conditions and selling worthless plans to uninformed people; that the largest funding to address the opioid crisis, the Medicaid expansion, would disappear; that their local hospital may have to close due to skyrocketing bad debts; and that individual bankruptcies would once again hit record levels as bill collectors return in force.” — J.B. Silvers, MarketWatch

Trump has now framed the stakes of the 2020 election.

“Trump has reset the 2020 race to once again to be about the central issue of access to affordable health care, especially for people with pre-existing conditions. That’s territory most Republicans would have just as soon avoided and on which Democrats are not only favored, they enjoy grassroots passion. Voters loudly rejected all of this in 2018. They will get to make this choice once again next year, this time for keeps.” — Andy Slavitt, USA Today

The push to kill Obamacare is a threat to the rule of law.

“Along the way, the Justice Department has trashed the duty to defend. That’s not to be taken lightly. The duty is a close cousin to the president’s constitutional duty to enforce the law. If the Justice Department really thinks that Obamacare is so blatantly unconstitutional that it can’t be defended, that implies that the president is violating the Constitution whenever he applies it. It’s not hard to see that as an incipient justification for refusing to enforce any law that the president believes to be unconstitutional, however ridiculous or partisan that belief might be. Hopefully it doesn’t come to that. But the failure to defend the Affordable Care Act is an ominous sign to anyone who cares about the rule of law.” — Nicholas Bagley, New York Times

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