The Affordable Care Act – “Obamacare” – marked its 14th anniversary this week, but if Trump (or any Republican) comes back into power, it will be its last. Trump did his level best to sabotage the ACA during his time, but this year, under Biden’s Administration, a record 21 million enrolled to obtain access to affordable health insurance, for a total of 45 million people having health coverage through ACA.
Before the ACA, 16 percent (50 million) Americans were uninsured; with this year’s record enrollment, that percentage has been cut in half, to 7.2%. Before the ACA, 26,000 Americans died each year for lack of access to timely medical and preventive care; now, everyone is entitled to an annual wellness check and preventive care. The ACA also helped cut the number of medical bankruptcies in half, though still high.
Before the ACA, being a woman was a “preexisting condition” that allowed for-profit insurance companies to charge higher premiums; before the ACA, people with pre-existing conditions could be denied health insurance altogether or face lifetime caps. There are 100 million people (millions more because of Long COVID) with preexisting conditions. Because of the ACA, your child can stay on your health insurance until the age of 26.
Because of ACA, private insurers cannot spend more than 20% of the premium on non-patient services (marketing, profit, management salaries). The ACA meant the federal government subsidized states’ expansion of Medicaid, and millions of seniors have lower prescription drug costs.
Because of the ACA, people are not bound like indentured servants to an employer, unable to change jobs or start their own business for fear of losing health care for their family.
And those death panels that Republicans kept fear-mongering about? Well they have developed but not because of the ACA, but because of theocrats passed abortion bans in 20 states that require a woman to be at death’s door before she can get treatment for a miscarriage or ectopic pregnancy, in violation of federal law mandating access to emergency medical care.
The ACA withstood nearly 80 attempts to repeal it by Republicans (not a single one voted for it). Trump celebrated with House Republicans when the Republican majority voted to repeal, only for it to fail by a single vote, courageously and dramatically cast by Senator John McCain, in the Senate.
And they are still at it, working to repeal Medicare’s ability to negotiate drug prices which saw insulin costs fall from an extortionist $400 to $35 (an insulin dose costs $10 to make and was never patented), and scuttle Biden’s plan to negotiate the prices of 10 major, life-saving drugs today, increasing the number to 50 in coming years.
There is a great and grave philosophical and practical difference between the Democrats and Republicans: Republicans believe healthcare is a privilege for those who can afford it and who follow a particular theology; Democrats believe healthcare is a right and health decisions should be between the patient and the doctor.
One-third of women now live in states where a doctor has to decide how close to death she is before they can provide care. While Republicans chide Democrats as being for “big government” and “big spending”, it is Republicans who have inserted politicians into a woman’s uterus.
At the time, Obama knew that the ACA was only a “downpayment” toward universal access to health care, but was all he could get in that political environment (and jeopardized his reelection).
Americans pay the most for health care, per capita, of any country in the world (17% of GDP), yet our outcomes including the level of maternal and infant mortality are the worst in the developed world. A truly universal health care system – which essentially cuts out the for-profit health insurance company middleman – and which puts realistic caps on profit – would cut costs by at least 20 percent, while still preserving the so-called individualism and innovation that a capitalistic system prizes.
Trump not only did his level best to sabotage ACA, but demonstrated his revulsion for public health. He shut down the pandemic response unit set up by Obama, then when COVID hit, Trump lied and mislead Americans about how the coronavirus spread and its lethality because it damaged his re-election prospects. (Mother Jones created a video catalogue of Trump’s grotesque mishandling of COVID in the first 100 days: https://www.motherjones.com/politics/2024/03/trump-covid-coronavirus-response-biden-four-years-video/)
Studies found that 40% of the one million COVID 19 deaths could have been avoided but for Trump’s failure – that’s 400,000 people. The US has 5% of global population but suffered 20% of global deaths. (https://apnews.com/article/donald-trump-pandemics-public-health-coronavirus-pandemic-f6e976f34a6971c889ca8a4c5e1c0068)
In contrast, a year after coming to office, researchers said 3.2 million lives were saved because of how fast Biden set up a system to distribute free vaccinations, masks, tests, and set up a National COVID-19 Preparedness Plan (https://thehill.com/policy/healthcare/3773239-covid-vaccines-saved-3-2-million-us-lives-researchers-say/).
When you think about it, the COVID pandemic provided the closest view of what “universal health care” would look like, and its importance for public health.
While Biden is allocating $100 million to find out why women are the vast majority of those who contract Alzheimer’s, are 80% of those with autoimmune diseases like MS or suffer miscarriages, and is calling on Congress to allocate $12 billion to research women’s health care, in contrast, Republicans seek to enact a national abortion ban with zero exceptions; make IVF illegal; ban medication abortion, limit access to contraception and shut down women’s health clinics. And they don’t like public health – not environmental protection, not clean water or clean air or pollution standards that would reduce illness and maladies, and surely do not support mandates to stop the spread of a deadly pandemic.
Congratulations anti-vaxers: you have resurrected small pox and measles, even here in Nassau County (attention visitors to Cohen’s Medical Center: you may have been exposed).
Heaven help us if Trump or any Republican is in charge when the next pandemic hits.
The ACA only gets us so far toward universal health care and the quality of life that it brings. But if you believe that health care is a right, not a privilege, then prevention and wellness have to be central to health care and the way communities are organized. That means structuring society – from residences to work places to communities – with health and wellness in mind with access to clean air, water, and outdoor recreation, making healthy foods affordable and accessible.
