Where are the ‘Obamacare’ defenders?

Two issues have been lost in the debate over repealing the Affordable Care Act: Will the president kill jobs, and where are those groups that stand to lose?

First, President Donald Trump asserts that he is all about creating jobs. Apparently that doesn’t include keeping existing jobs, particularly in the health sector. He wants health coverage for everyone, yet he throws bombs into the delicate, complex structure of the Affordable Care Act and threatens to ruin health care in America.

Instead of reducing employment (ACA as “job killer”), more than 11 million jobs were created in the five years following enactment in 2010. (Private health care sector jobs increased by 23 percent.)

New analyses show that 3 million jobs will be lost with repeal, which will cost $350 billion, $28 billion in New Mexico.

The facts are that more than 20 million have gained insurance since passage of the Affordable Care Act, and at least 18 million will lose it with repeal; 250,000 New Mexicans will close coverage. Low- and moderate-income families will be hurt the most.

At the very least, the president’s actions, and soon those of the Congress — will create turmoil in the insurance market, for health care providers and for the population. Republican substitutes will only benefit the wealthy.

Second: Where are the interest groups — the American hospital Association, the hospital chains, the American Medical Association and other physicians’ groups, America’s Health Insurance Plans and other insurance groups? These groups have played major roles in all previous health care and financing reforms, including Medicare and Medicaid, and got what they wanted in the Affordable Care Act. They will lose when the ACA is shredded.

Why? The ACA is a delicate balance. Subsidies that used to protect hospitals in particular have ceased to exist, replaced by insurance. In other words, now that we have 20 million more people with insurance, we don’t need the safety net payments — payments to hospitals that serve a disproportionate share of people without insurance (Disproportionate Share Hospitals) and extra payments to hospitals who must serve the uninsured because they are the only hospital in the area (Sole Community Provider). These are gone.

Hospitals have been restructuring to provide more outpatient and community care in order to gain the revenue from newly insured people. Insurance coverage means people can see a doctor when they need to instead of waiting until they need hospital treatment.

Rolling back the new ACA elements and replacing them with the old ones simply will not happen. If the mandate disappears, the rest will collapse — without the mandate, insurers will have to raise premiums because their population will be sicker.

So where are the organizations and entities who stand to lose? Are they afraid to speak up? One can only hope the heavy hitters of the health care world are holding secret talks with GOP legislators and are working to prevent a catastrophe in the health and medical care system. Not to mention stanching the loss of jobs when people can no longer afford to get care. Insurance companies will lose millions of clients. Hospitals will lose revenues. Doctors will lose patients.

Many things need fixing in the Affordable Care Act, but blind ideology has prevented any congressional effort to do so. Tearing down the whole edifice will have unintended consequences that will make us poorer, sicker and more unemployed. Think about that, Mr. President. You say you are about jobs? Prove it. And where are you, hospitals, doctors and insurance companies? Are you seriously ready for economic and financial chaos?