Ten years after the passage of the Affordable Care Act, health care remains a critical issue.
The COVID-19 pandemic, and the death of Supreme Court Justice Ruth Bader Ginsburg, have put health care front and center with unparalleled urgency. In just seven months, the virus has swept through every corner of our nation, killing more than 200,000 Americans, taxing medical professionals to the point of collapse and leaving millions without jobs.
Because roughly half of working Americans get their health insurance through their employers, families now find that coverage threatened at a time when it might be needed most. Should the ACA be repealed by the U.S. Supreme Court, millions of Americans could lose health insurance.
Even before the pandemic, Texas had the highest uninsured rate of any state at 18.4 percent, double the rate of the nation as a whole in 2019. It didn’t have to be this way. Texas could have expanded Medicaid.
In San Antonio, nearly 283,000 people were uninsured last year; at 18.5 percent, that’s the highest percentage since 2013. And that was before the coronavirus exploded on the scene.
The Affordable Care Act, a popular yet controversial law, expanded coverage significantly by allowing Americans to purchase health insurance through state and federal marketplaces, and by allowing young adults to remain on their parents’ health plans until age 26. It made that coverage affordable for many through subsidies and new rules, including one that bans denying coverage to those with pre-existing conditions.
Today, some 23 million people are covered under the ACA through a combination of expanded Medicaid and subsidized private insurance. That has not stopped President Donald Trump from continuing to chip away at former President Barack Obama’s signature legislation.
Trump rode into the White House in 2016 promising to repeal and replace the ACA, but his efforts have fallen short so far. While he managed to eliminate the highly unpopular individual mandate, he has been unable to repeal the law completely or draw Republican consensus on a replacement plan.
In a recent town hall-style meeting, Trump alluded to a soon-to-be-revealed “great” health plan that would replace the ACA with something much better, while maintaining protections for people with pre-existing medical conditions. It has not surfaced, and last week he signed an executive order vaguely promising to preserve coverage for pre-existing conditions. It is a vapid and hypocritical gesture.
Trump has spoken of lowering drug costs, ending surprise medical bills, reducing regulations, improving the transparency of health care costs and increasing competition. But weeks before Election Day, he has failed to offer much in the way of specifics — and his actions have undercut access to health care.
As vice president under Obama, Joe Biden helped build legislative support for the ACA in the Senate. As the Democratic presidential nominee, Biden’s health care plan calls for strengthening that law. He proposes increasing eligibility for subsidies and adding a government-run “public option,” or Medicare-like plan that people could choose over private insurance coverage. Biden also wants to lower the Medicare eligibility age from 65 to 60, restore and expand reproductive rights, and put the federal government in charge of the COVID-19 response.
Trump has delegated the COVID-19 response to the states, restricted access to reproductive health services, and proposed changes to cap and limit eligibility and federal funding for Medicaid.
Throughout the pandemic, he has downplayed COVID-19’s seriousness, expressed disdain for masks and social distancing, discouraged people from getting tested and muzzled government scientists.
The choice here is between expanding access to health care or constraining it, between offering a plan or empty tweets. It’s a choice that arrives with the fate of the ACA hanging in the balance with the Supreme Court. The case is scheduled for argument after the election.
Trump supports this lawsuit brought by a consortium of Republican-led states — led by Texas — to overturn the ACA. If the states are victorious, it is uncertain what that would mean under a second Trump term for the millions of Americans who rely on the ACA for coverage, or its most popular provisions.
We are still waiting for him to deliver on his pre-inauguration promise of a “terrific,” “phenomenal” and “fantastic” new health care plan to replace it.