So here we are again. After years of promising to “repeal and replace Obamacare,” Republicans learned in 2017 that coming up with an alternative to the law was harder than it looked. Or as Trump infamously put it: “Nobody knew health care could be so complicated.”
They got a flimsy bill through the House, but their drive to repeal the ACA died in the Senate. The blunder cost the GOP dearly. By putting the law in jeopardy, they achieved what the Democrats who passed it never could: They actually helped make Obamacare popular. Positive feelings began exceeding negative ones almost from the moment Trump and congressional Republicans went to work to dismantle it.
The president’s party also handed its opponents the issue that, more than any other, won the House back for the Democrats in last year’s midterm elections.
Republicans were dismayed at Trump’s decision to revisit the treacherous terrain of health care. And he did it, no less, just as they were riding high with the all-clear signal from special counsel Robert S. Mueller III’s investigation regarding Russian interference in the 2016 presidential election.
The administration was already on record as favoring a partial dismantling of the law — which, among other things, would end its guarantee of coverage for people with preexisting conditions. But now it has thrown its support behind getting rid of the whole thing, and with no apparent plan for what to put in its place.
The Justice Department stated its new position in a one-paragraph filing with the U.S. Court of Appeals for the 5th Circuit in New Orleans, where an appeal is pending on a district judge’s ruling that the ACA is unconstitutional.
What would it mean if the law disappeared and things went back to the way they were before President Barack Obama signed it nine years ago?
For starters, the number of uninsured people in this country would increase by nearly 20 million, according to an analysis by the Urban Institute. That would include an estimated 15 million who gained coverage through the expansion of Medicaid in the 37 states that have done so under the ACA.
The act also provided popular benefits to those who do have coverage. It allowed parents to keep their adult children on their policies until they are 26 years old. And for seniors, it closed a coverage gap — known as the “donut hole” — in their Medicare prescription drug benefits. The law has other features as well — for instance, requiring chain restaurants and vending machines to provide nutrition information about the food they sell.
Trump may be going through this as a theoretical exercise merely to please his base. After all, the Supreme Court has already ruled twice that the key parts of the ACA are constitutional.
But it may also be that Trump believes that the hardball tactic will somehow bring Democrats to the negotiating table. If that is the case, he is making the same miscalculation he did when he shut down the government on the assumption that it would give him leverage to get the money he wanted to build his border wall.
No one would argue that the ACA has worked perfectly. And many Democrats are at risk of running too far in the other direction as they tout Medicare-for-all, a government-run system that would replace private health insurance.
But they are delighted to change the subject from the Mueller investigation. In the House, Democrats introduced legislation Tuesday that aims to provide additional tax credits and subsidies for families struggling to buy coverage in the ACA marketplace and strengthen protection for people with preexisting conditions. Speaker Nancy Pelosi (D-Calif.) told her members during a closed caucus: “This is a path to everything else.”
As it happens, Tuesday was Pelosi’s birthday. And Trump just handed her the best gift she could have hoped for.