Tax bill, attacks on ACA betrayals of Trump voters
President Trump claimed again Tuesday that the Republican tax bill “essentially Repeals (sic) over time ObamaCare. . .” As with so many of the president’s claims, this one is bogus.
The legislation does end — in 2019 — the requirement that Americans have health insurance. New numbers, however, also show that the Affordable Care Act remains healthy despite repeated political malpractice.
As of last week, 8.8 million Americans had signed up for coverage through healthcare.gov, the law’s website. That compares with 9.2 million new and renewed enrollments a year ago.
Given the obstacles Trump created, a mere 4 percent drop at this point — the numbers aren’t final — is extraordinary. The Trump administration cut the signup time in half — from 90 days to 45 days — two years earlier than the Obama administration had planned. Trump cut money for advertising and for volunteers to help people enroll. Trump repeatedly mentioned the increases in premium, threatened to end the law’s subsidies to insurers and pronounced the law “dead.”
Yet to many Americans seeking coverage in the individual market, the Affordable Care Act — however flawed and politically perilous — remains essential. John McDonough teaches at the Harvard School of Public Health and advised Senate Democrats during the ACA debate in 2010. The law, McDonough told the Associated Press, “is more durable and important to Americans in terms of getting affordable health insurance than even its advocates expected.”
The ACA also is more than the mandate. It is the millions who have obtained coverage through Medicaid expansion. It is the ban on insurers refusing or overcharging people who have pre-existing conditions. It is the ability of parents to keep children covered under their policies through age 26. It is tougher accountability for Medicare payments to hospitals.
Benefits of the Republican tax bill that also seeks to undermine the ACA skew disproportionately to the wealthy and corporations. It thus betrays lower-income voters who put Trump in office. Unlike Trump, they don’t own real estate “passthrough” companies. The break for those entities could save Trump $11 million, based on his 2005 tax return.
Remember Trump’s promise of a $1 trillion infrastructure program? Tax breaks came first, before blue-collar jobs. Any plan now will further raise the deficit and debt. And attacks on the Affordable Care Act also represent attacks on states that voted for Trump.
The Associated Press reported that 83 percent of 2018 signups came from states that Trump carried. He won all four states with the highest totals — Florida, Texas, North Carolina and Georgia. In Florida, signups roughly equaled those for 2017. Eleven states beat their 2017 totals. Trump carried eight of them, most by double digits.
Though the law’s favorability rating has inched up steadily, even supporters acknowledge its flaws. It was clear seven years ago that Congress would have to regularly update the law.
One problem is that healthier people who had been buying individual policies before the law have paid higher premiums and out-of-pocket costs because they make too much to quality for the subsidies that drastically lower most ACA marketplace premiums. Kaiser Health News reported that most of these Americans are self-employed and several years short of 65, when they can go on Medicare.
Another problem is the coverage gap for the working poor in states like Florida that haven’t expanded Medicaid. It is not a coincidence that, according to the Kaiser Family Foundation, 62 percent of those Americans live in the states that had the most 2018 ACA signups.
A bipartisan approach could address those problems while keeping the popular, more successful parts of the law. Some Republicans, however, still vow to “repeal and replace” the ACA. Perhaps they at last will offer a suitable replacement.
For now, we will see if Congress keeps promises Senate Majority Leader Mitch McConnell, R-Ky., made to Sen. Susan Collins, R-Maine, for her support of the tax bill. Collins wants $18 billion over two years to supposedly stabilize the Affordable Care Act market.
In 2010, Republicans retook the House in large part because they misrepresented the Affordable Care Act and Democrats offered weak responses. Imagine the irony if the GOP’s continued assault on the law, combined with the party’s embrace of the rich, tips the House and or the Senate back to Democrats in 2018.
Email Randy Schultz: randy@bocamag.com