Does it make sense, especially during a pandemic, to end the Affordable Care Act (ACA, or Obamacare)? Donald Trump and the Republican Party evidently think so.
Last month, the Trump administration urged the U.S. Supreme Court to overturn Obamacare. This case was originally brought by 18 Republican state attorneys general, who claimed that a tax bill passed by Congress in 2017 that ended the monetary penalty for being uninsured meant that the whole ACA is now unconstitutional. Although legal experts said this argument was incredibly weak, the Supreme Court will likely hear the case in the fall.
Why should this concern you and everyone you know? Despite its controversy, Obamacare brought many rights and protections for every American. It expanded the ranks of the insured by many millions. It required insurance companies to cover people with preexisting conditions and without higher rates for these conditions. It prohibited charging women more than men and sick people more than healthy people. It told companies they couldn’t cancel policies if your medical bills were too high, and it eliminated annual and lifetime limits on what they spend on your health care. It made many preventive services free, including breast cancer and diabetes screening for adults and lead blood level screening for children. It also said dependent children may remain on their parents’ insurance policies until age 26.
If Donald Trump and the Republican Party succeed in the Supreme Court, all these rights and protections will vanish, with these dire consequences: 23 million Americans will likely lose the insurance they gained under Obamacare; 130 million Americans with preexisting conditions, including the millions who end up with Covid-19, could also lose their insurance or at least pay much higher rates; women and sick people could again pay higher rates than men and healthy people; and the free screenings that help protect so many Americans may disappear.
The Republican Party has repeatedly tried to weaken or end the ACA since its passage a decade ago. This effort nearly succeeded in 2017, when a Senate measure to repeal major elements of the ACA failed by one vote. In speeches and tweets, Trump has championed the ACA’s repeal. Yet in the decade since the ACA’s passage, he and Republicans have failed to come up with a viable alternative that would preserve all the rights and protections that Americans have been enjoying under Obamacare.
The ACA was a laudable if imperfect attempt to bring U.S. health care into line with the world’s other democracies, all of which offer universal coverage. They do this in different ways, but the bottom line is that virtually all citizens in these nations have affordable health insurance and, partly as a result, also boast better health overall than that of the average American and at far lower cost.
If Trump and the Republican Party get their way, America will go back to the time when people with preexisting conditions could not obtain health insurance, when people who were sick lost their insurance or had their premiums increased, when people had to pay for all their health care if they exceeded annual or lifetime limits, when women were charged more for insurance than men, and when many preventive screenings were too expensive to afford.
The repeal of Obamacare will not make America great again. Instead it will once more put us at the mercy of insurance companies, and it will worsen many people’s health and cause much premature death and needless suffering. This is not an America that any of us should want again, but it is exactly the America that Trump and the Republican Party want us to have again.
Steven E. Barkan is professor of sociology at the University of Maine and the author of “Health, Illness, and Society: An Introduction to Medical Sociology.” This column reflects his views and expertise and does not speak on behalf of the university. He is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.