As Donald Trump gets around to reinventing himself for the general election, here's a section of his stump speech that merits a second look — his vow to repeal and replace Obamacare. That's not only because his own take on health care reform (at least what can be gleaned from the less-than-detailed outline he's offered to date) would cost the federal government hundreds of billions of dollars but also because it would deny health insurance coverage to millions of Americans.
The latest statistics from the Centers for Disease Control and Prevention reveal that the Affordable Care Act continues to provide health coverage for the uninsured. As of the end of 2015, only about 9.1 percent of U.S. residents did not have coverage, according to the CDC survey. The findings show that at least 16.2 million fewer Americans lacked insurance coverage as of December 31 than two years earlier.
Whatever faults Obamacare may have — and it's been no panacea for the shortcomings of health care in this country — even its harshest critics must recognize those 16 million to 17 million people (depending on whose estimates one uses) who have received a literal lifeline from health care reform. Not only does a lack of insurance worsen and shorten lives, it puts millions of working families at risk of financial ruin — as anyone who has suffered a major illness while not having the benefit of insurance can attest.
Lest anyone forget, the Affordable Care Act made it possible for people with pre-existing conditions to buy insurance without penalty and for those earning 133 percent of the federal poverty level to qualify for Medicaid (at least in those states that welcomed the federally-subsidized Medicaid expansion). The result has been a steady shrinking of the number of uninsured each year since Obamacare went into effect, particularly in the states that operated their own exchanges and chose to expand Medicaid coverage for the working poor.
Where has the ACA fallen short? Clearly, it's not doing enough to cap insurance costs, even though insurance rates have risen less precipitously in recent years than they did before Obamacare took effect. The outlook for a major premium increase — for example, an anticipated 8 percent in California next year — and a drop of providers from the marketplace (most recently by UnitedHealthCare which provides insurance to about 1 million health exchange patrons) do not bode well. But they are reasons to shore up the ACA model, not to scrap it.
What Mr. Trump has offered to date would mean no more Obamacare-related taxes and no more Obamacare-related subsidies and no more insurance mandate. The rest is fairly marginal — such as health care savings accounts that do little for people who can't afford to put money in them or allowing insurers to more easily compete across state lines. Meanwhile, scrapping the mandate would inevitably increase costs as providers lose sales volume. The net effect is that millions will lose coverage and those who retain it are destined to pay considerably more.
Clearly, what ails the Trump health care plan is the same problem that ails the Republican majority in Congress — the call to "repeal and replace" Obamacare is really a call to repeal and then allow millions of Americans to suffer the consequences. It's simply not a serious strategy to address a complex and chronic problem. And one of the first groups to suffer will be children, as studies have shown one of the more striking effects of the ACA has been to get more low-income kids signed up for health insurance coverage under Medicaid and the Children's Health Insurance Plan or CHIP (with more than 90 percent of eligible children now enrolled).
Whether the country is ready to embrace an even greater expansion of health insurance access — such as Sen. Bernie Sanders has promoted through a single-payer model — is a conversation for another day. The greatest and most immediate health care threat facing the nation is the possibility of a chief executive and a GOP Congressional majority willing to turn their backs on all those millions of Obamacare beneficiaries — including all those average Americans who now take for granted their ability to buy health insurance despite a pre-existing condition or to keep dependents on a family policy until the age of 26, all made possible by the unfairly maligned health care law.