President Obama returns to sweet home Chicago Tuesday night to say farewell to the nation. It will be an evening of joy, tears and pride in a job well done, despite the harsh headwinds of resistance he faced every day for eight years.
As President Obama enters into his last days in office, surely his greatest legacy is the Affordable Care Act. Twenty million people have received health care coverage under the act, largely from the extension of Medicaid to cover lower-wage workers and their families. Insurance companies have not only been required to deal fairly with those afflicted with ailments, they have also been forced by law to limit what they rake off in administration and profits. This is a big deal.
Lives are being saved; illnesses are being treated. Family finances are being protected. A smaller percentage of Americans go without coverage than ever in the history of the country. This is the most important extension of health coverage since the passage of Medicare under Lyndon Johnson.
Millions more, however, were turned away on the altar of meanness and ideology. So, naturally, the Republican Congress — dedicated to reversing all things Obama — has made repealing the Affordable Health Care Act, or what they call Obamacare, its first order of business. Repeal — plus the defunding of Planned Parenthood’s programs for women’s health — is the centerpiece of the reconciliation bill Republicans plan to push through Congress immediately.
This opposition to the Affordable Care Act is founded in large part on racial delusions. 1Blue-collar white voters, particularly in the Midwestern states that gave Trump the election, were the most skeptical about the law.
As Ronald Brownstein pointed out in the Atlantic, based on data from the Urban Institute, “more non-college-educated whites gained coverage than college-educated whites and minorities combined in all five of the key Rustbelt states that flipped from Obama in 2012 to Trump in 2016: Iowa, Ohio, Michigan, Wisconsin, and Pennsylvania.” There were stunning reductions in the number of uninsured blue-collar whites in states that Donald Trump won in November — roughly 50 percent in Ohio, Iowa and Michigan, 60 percent in West Virginia and Kentucky, and 40 percent in Indiana, Pennsylvania and Wisconsin.
This was largely because these states adopted the ACA extension of Medicaid to cover lower-wage workers. Where Republican governors refused to extend Medicaid, low-wage workers of all races were left out.
Trump has promised that he would not allow people to “die on the streets” with health care repeal. He also promised not to touch entitlements — which would include Medicaid as well as Medicare and Social Security. He named GOP Rep. Tom Price to head the Department of Health and Human Services, however, and Price has detailed and destructive plans for what comes after repeal of ACA.
He would roll back the Medicaid extension, much of the subsidies for others getting insurance in the exchanges, and much of the regulation forcing insurance companies and hospitals to limit price hikes. If he has is way, Price will go after Medicare and Social Security as well. The result will be to strip many of the 20 million — whites and people of color — of the health coverage they now have.
This calamity is utterly unnecessary. ACA, as the president has stated, has flaws and is in need of reform. The best first steps would be to crack down on drug company prices and to create a public option in the exchanges that would help keep insurance companies honest. Neither of these reforms is on the Republican agenda.
Twenty Republican senators come from states that extended Medicaid. For ACA to be repealed, they have to sign onto to punishing lower-wage workers in their states who are covered under Medicaid extension, among others. In fact, many more people are likely to take a hit. Republicans now plan to repeal ACA without a plan to replace it. That is likely to unravel not just the Medicaid extension but also the exchanges and the curbs on insurance companies and health care complexes. People now rightly complain about the cost of our health care. Republicans are about to make that worse.
President Obama has sensibly said that he will support any Republican plan that is in fact better than ACA. Despite Republicans’ posturing, they offer nothing that meets that test.
Donald Trump’s bumptious course as president-elect has made Americans appreciate even more the grace and maturity with which President Obama governed. Now Republicans, in their hurry to eviscerate Obama’s historic accomplishment, are about to make us appreciate it all the more. But unless a handful of Republican senators break ranks, that appreciation will come too late to help the millions that will be placed at risk.