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For much of his first term, President Trump has claimed that significant proposals would be coming “soon” or “in a few weeks” or, often, “two weeks” — notably health care. He has been saying a cheaper health plan that would provide better coverage for all Americans than the Affordable Care Act has been just around the corner since the early days of his campaign in 2015. With two weeks until Election Day — and millions of votes already cast — the clock is ticking for Republicans as Democrats reprise their successful midterm strategy of warning that the administration and the GOP want to end mandated coverage for preexisting medical conditions.
In fact, it does, although it is trying to convince voters otherwise. Since the Affordable Care Act, or Obamacare, was signed into law in 2010, Republicans — including Trump — have campaigned on repealing it and replacing it with something “better.” After taking office in 2017, Trump failed to deliver despite the fact that Republicans had control of both chambers of Congress. Republican-governed states turned to the courts, bringing a lawsuit that would have the effect of overturning the ACA, which the Trump administration has joined. The case is set to be heard by the Supreme Court next month, and if Republicans succeed in seating Judge Amy Coney Barrett, she could cast the deciding vote.
Without protections for preexisting conditions provided by Obamacare, the Kaiser Family Foundation estimated in 2016 that up to 52 million people could be denied coverage. Millions more would lose insurance if the ACA’s Medicaid expansion were thrown out. A full repeal with no immediate replacement plan could also hurt the fight against opioid addiction and HIV, and would come during the coronavirus pandemic, which has killed more than 220,000 Americans and left many others with lingering health issues.
Last month, Trump rolled out a plan that he said would protect preexisting conditions, but it was a slogan, not proposed legislation. White House officials said that his “protections” for preexisting conditions would not actually be law should the ACA be repealed, but were a “defined statement of U.S. policy.” If the ACA is overturned by the Supreme Court, a “defined statement of policy” does not provide a legal mechanism to prevent insurance companies from refusing coverage to those with preexisting conditions, or charging so much for it as to make it unaffordable in practice.
During the September rollout, the White House also announced that Trump would be giving Congress a Jan. 1 deadline to pass legislation on surprise medical billing and encouraging more health care choice. In recent rallies, Trump has touted the importance of price transparency in lowering health care costs, but there are limits to the effectiveness of being able to “shop around” for health care if you live in a rural area where there’s only one hospital or are unconscious in the back of an ambulance, being transported for emergency care.
Republican attacks on the ACA have only made the law more popular, with a Fox News poll in June finding 56 percent support (up 4 percent from the prior year); a September Morning Consult poll pegging it at 62 percent; and tracking from the Kaiser Family Foundation finding 55 percent in favor. A New York Times/Siena College poll released Tuesday showed not only majority support (55 percent) for the ACA but also 67 percent backing for the plan supported by Democratic nominee Joe Biden, supplementing Obamacare with a “public option” of a government-run health care plan.
A majority of Americans opposed Republican plans to repeal the ACA in 2017, as studies found that the party’s alternatives would cause millions to lose their health insurance, along with AARP estimating it would raise health care costs for older Americans by thousands of dollars. Congressional Republicans and the Trump administration have yet to propose an alternative palatable to the American public, while Democrats have been debating expansion of coverage including a public option and the single-payer Medicare for All plan advanced by Sen. Bernie Sanders, I-Vt.
“Now, I have to tell you, it’s an unbelievably complex subject,” Trump said in February 2017. “Nobody knew health care could be so complicated.”
Health care was a top issue for Democrats in 2018 when they retook the House in the midterm elections, with House Minority Leader Kevin McCarthy blaming GOP losses on the party’s attempts to overturn the law. Attorney General William Barr was reportedly among those who urged Trump not to push for a full repeal. Democratic candidates were eager to engage on the topic.
In South Carolina this year, Democrat Jaime Harrison has made a tight race of his campaign against Sen. Lindsey Graham in part by focusing on a 2017 ACA replacement co-authored by Graham that Harrison claims would have ended health coverage for millions. In North Carolina, Republicans are trying to turn the focus to the extramarital affair of Democrat Cal Cunningham, but the challenger is maintaining his focus on health care as he attempts to unseat Republican Sen. Thom Tillis. In Iowa, Sen. Joni Ernst is being hammered by Democrat Theresa Greenfield for her repeated votes to repeal the ACA, dating back to the 2014 campaign, during which Ernst released an ad that showed her firing a handgun while the narrator said, “Once she sets her sights on Obamacare, Joni’s gonna unload.”
Earlier this month, Ernst was one of five vulnerable Republicans — the others were Sens. Martha McSally of Arizona, Susan Collins of Maine, Cory Gardner of Colorado and Dan Sullivan of Alaska — to vote for a symbolic bill against the lawsuit to end the ACA. Ernst is also, however, set to vote to confirm Barrett, whose confirmation hearings last week were used by Democrats as a platform to discuss health care.
“This Supreme Court nominee has signaled in the judicial equivalent of all caps that she believes the Affordable Care Act must go and that the precedent protecting the ACA doesn’t matter,” said Sen. Sheldon Whitehouse, D-R.I. “The big secretive influences behind this unseemly rush see this nominee as a judicial torpedo they are firing at the ACA.”
“President Trump has promised over and over and over again that he would repeal the Affordable Care Act,” said Sen. Chris Coons, D-Del. “He ran on that promise, but despite his very best efforts, he failed. My Republican colleagues here and in the House have voted over and over and over to repeal the Affordable Care Act since it was passed a decade ago, but thankfully for the people of our nation and my state, they too have been unsuccessful. And yet today, to make good on that promise to achieve what they could not accomplish through the democratic processes, they’re looking to the courts — in fact, to the court. They’re looking to this nominee.”
Signaling Republicans’ desire not to be associated with ACA repeal, and implicitly acknowledging that it would be unpopular, Sen. Chuck Grassley, R-Iowa, dismissed the idea that Barrett would vote to overturn the law because she is a mother. (The four justices who voted to repeal the ACA in 2012 were fathers.) During her hearing, Barrett claimed she wasn’t familiar with Trump’s repeated claims that he would only nominate judges who would repeal the ACA, and, as nominees almost always do, declined to say how she would vote on a future case.
But those who are dependent on the protections in the ACA may have found it less than reassuring that she also declined to say whether Medicare — the government plan that provides health insurance for older Americans and has been in place for more than 50 years — was constitutional.
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