Republicans couldn't kill Obamacare. They’re stupidly trying again.
Attacking Medicaid expansion when it's more popular than ever. FAFO.
The cruelty in the “beautiful” Republican budget is surpassed by its stupidity: It would deprive millions of Americans of health insurance coverage at a time when government-financed health insurance is more popular than ever.
By one important measure — public opinion of the Affordable Care Act (nee Obamacare) and the expansion of Medicaid coverage that came with it — the 215 House Republicans who voted this week to make huge cuts to Medicaid should be looking at real trouble in the midterms, a grand case of FAFO.
Remember when they tried to repeal the ACA during Trump’s first presidency? It failed — famously, with a big thumbs-down from the late Republican Sen. John McCain — and the GOP’s attack on the law actually made it more popular.
Public support for ACA grew after the repeal attempt.
Most polling on the ACA now shows support in the 60% to 65% range.
The law passed in 2010 and nearly 50 million Americans have health insurance because of it. The ACA’s Medicaid expansion provision, extending coverage to nearly all adults with incomes up to 138% of the federal poverty level ($21,597 for an individual), is alone responsible for more than 20 million Americans having health insurance.
Note: While 40 states and the District of Columbia accepted the ACA’s Medicaid expansion, there are still 10 states — all of them red — where low-income residents have been deprived of the benefit. Eight of those states have Republican governors; all have legislatures controlled by Republicans. The legislatures have refused to take the federal funds for the Medicaid expansion.
I should also note — because historic perspective is always helpful — that House Republicans tried to repeal the ACA nearly 70 times, culminating in the biggest failure of all, with McCain’s rejection of the attempt, in 2017.
At one point, Republicans gave up trying to kill the ACA, having determined that it was a loser of an issue for them; too many of their constituents were benefiting from it. (Just one example close to home: Andy Harris, the extreme-right Republican from Maryland, constantly opposed the ACA, and yet nearly 190,000 residents of his congressional district are on Medicaid. Harris was the only Republican to vote “present” on the House budget this week.)
Republicans are back at their guns, trying again, with the miserable budget they just sent to the Senate, to undercut the ACA. A large chunk of the $800 billion in Medicaid cuts will come out of the ACA provisions, depriving some 8.6 million Americans of coverage.
In addition, the Republican budget rejects extending “enhanced premium tax credits” that help millions more buy insurance on the marketplace.
This all looks politically stupid to me, but if Republicans want to go this route — so they can extend big tax breaks to the wealthiest Americans — have at it. FAFO.
One more note about this: Back in the Obama days, when Democrats were pushing the ACA, the most convincing argument was that it would arrest a growing crisis.
Coming out of the Great Recession (2007-2009), there were an estimated 50 million people without health insurance. Everyone else — those of us who had private insurance — paid for those who could not afford it, up to an average of $1,100 a year in our premiums. When the uninsured got sick and walked into a hospital for treatment, the hospital treated them and passed the cost along to the rest of us. So I never understood why Republicans opposed having wealthier Americans paying a little more in taxes to have a system that covered everyone and, eventually, saved the rest of us (and our employers) some money.
And that was before Trump and MAGA. The continued efforts to tear down the ACA are cruel — and stupid.
Followup: In Wednesday’s post about Maryland Gov. Wes Moore’s veto of a reparations bill and his potential as a presidential candidate, I missed the mark a bit. While it could hurt Moore among the Democrats who would be needed to secure a nomination (Black voters and progressives), the veto looks like a calculated effort to come off generally as a not-so-woke centrist. As the editorial writers used to say (when they could not come up with a better closing line): This bears further watching.
Thank you for pointing out the way in which we all bear the cost of uninsured people. Hospital rate setting takes unreimbursed costs into account when rates are calculated as well as in the premiums we all pay for health insurance. I’d also like to add that tying our health insurance to employment is really stupid. If an insured person experiences a traumatic accident or medical occurrence like cancer and requires extensive long-term care for recovery, they often will lose their job and subsequently their healthcare benefits. It makes no sense for our country to allow its citizens to go into debt over a medical crisis. It also contributes to our collective lack of competitiveness in the business sector since employers have to add the cost of health insurance for the cost of operation.
You correctly point out that urgent and emergency care will be delivered to anyone, regardless of insurance, and the cost of indigent care will be borne by everyone else, government or no government. The alternative is licensing hospitals to let people suffer and die for lack of funds. And most often, the uninsured delay seeking treatment until the last possible and most expensive moment. ACA attempts to put the public in front of this problem through primary care and early detection AT LESS COST TO THE AVERAGE CITIZEN.