Only 24 hours after what he sees as a vindication of his presidency by Attorney General William Barr, President Donald Trump took the most radical, aggressive and harmful move of his presidency when he filed papers to ask the courts to support the complete elimination of the Affordable Care Act.
And in doing so, Trump just framed the stakes of the 2020 election.
In an administration that has attempted to ban Muslims from entering the country and separated small children from their parents, this stands out in some ways as an even more defining step because the impact reaches to nearly every American family.
Trump’s action would be by far the most far-reaching of his presidency. Americans who have pre-existing conditions, numbering 130 million, would no longer be assured of insurance coverage as they are today; that would be up to insurance companies. Twelve million seniors would see significant increases in prescription drug costs at a time when Americans rate this is a top issue. The law’s Medicaid expansion, which has covered millions of low-income Americans, would end. Over 2 million young adults would be kicked off their parents’ plans. Nine million people who receive subsidies to buy insurance would lose them. The uninsured rate would jump 65 percent.
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And those are just some of the easier-to-see effects. So much of how the health care law works for people behind the scenes — from regulations requiring 80 percent of your premiums to be spent on health care, to rules that prevent people over 50 from being massively surcharged, to the outlawing of lifetime limits or higher costs for women — would disappear.
Vital progress in making health care more sustainable and affordable would be lost. We’d see the end of major national initiatives that focus on prevention, better health and the authority to pay doctors and hospitals for better health and lower costs instead of fee for service. Hospitals, doctors, and nurses would see their operations flipped on end, almost certainly resulting in the closure of rural hospitals and reduced access for basic services.
It’s a neutron bomb. Only insurance companies and people who haven’t experienced an illness yet would be left standing.
Democrats roll out new health proposals
This radical agenda comes at a time when Republicans had been hoping to frame Trump’s 2020 re-election as a last stand against Medicare for All and full-on socialism. Democrats seeking the presidential nomination have endorsed a number of ways to expand health coverage and some have signed on to multiple bills that range from modest proposals to the sweeping Bernie Sanders plan that would eliminate private insurance coverage. While Sanders is most identified with this idea, it was a more uncomfortable spot for many of the candidates..
In contrast to Trump’s neutron bomb and claims of a Democratic socialist agenda, House Democrats introduced a very serious, pragmatic bill Tuesday to fix some of the ACA’s challenges, address affordability, and stop the Trump administration agenda of sabotaging the law and most prominently, pre-existing condition protections. Their proposal would mean that nearly all Americans, including those in the middle class who didn’t qualify for ACA subsidies, would never need to pay more than 10 percent of their income for health coverage.
Most new jobs today and into the future don’t provide insurance. So a proposal like the one from House Democrats, making it easier for Americans of all ages, employment levels and health conditions to get affordable health insurance, is important — and not just to the public. It’s also important to jobs, the economy, and growth.
Trump reset 2020 focus to health care
What can we learn from Trump’s action here? First, that Trump and Republican claims during the 2018 midterms that they favored pre-existing condition protections were what they appeared, an election-year lie that voters never bought. Republicans are running as the party that favors eliminating protections and putting the power of life and death in the hands of the insurance industry.
Second, we learn how Trump chooses to spend the political capital he thinks he’s earned: with a radical agenda that would leave as broad and lasting and damaging an imprint as anything he could do. This complements proposed cuts of nearly $1 trillion to Medicare and $1.5 trillion to Medicaid in his recent budget.
Third, Trump has reset the 2020 race to once again to be about the central issue of access to affordable health care, especially for people with pre-existing conditions. That’s territory most Republicans would have just as soon avoided and on which Democrats are not only favored, they enjoy grassroots passion.
Voters loudly rejected all of this in 2018. They will get to make this choice once again next year, this time for keeps.
Andy Slavitt, a member of USA TODAY’s Board of Contributors, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt