Semro column: Destroying health care as we know it
Donald Trump released a brand new TV campaign ad last month. The ad was timed to coincide with the second round of Democratic presidential debates. According to the ad the Democrats running for President are “radical, reckless socialists.”
Trump claims that Democrats are “calling for socialized medicine” and are set on “destroying health care as we know it.”
I’ve got a lot of problems with the ad, including the red-meat references to socialism and socialized medicine. But my biggest problem was the statement that Democrats are out to destroy health care as we know it. By extension, that implies that the Trump administration and Republican members of Congress are out to save it.
That’s a little like somebody pouring gas all over their neighbor’s house, setting it on fire with a blow-torch and then claiming that they actually work for the fire department.
And instead of debating the ideological purity of Medicare-for-all and the track record of the Obama administration, Democratic candidates might want to take a trip down memory lane and remind voters of what their opponents have done for health care over the last two and a half years.
To begin with, according to the Gallup Health and Well-Being Index, 18 percent of American adults had no health insurance in 2013. That percentage dropped to around 10.9 percent in 2016 after the Affordable Care Act (ACA) was fully implemented. Under the Trump administration, the number of adults without insurance climbed back up to 13.7 percent by the end of its second year in the White House.
To put a number on it, according to an April report from the non-partisan Congressional Budget Office (CBO), 1.4 million fewer Americans have health insurance coverage since the end of 2016.
Worse yet, according to CBO projections, the number of non-elderly uninsured Americans will increase by 5 million over the next ten years, from 30 million in 2019 to 35 million in 2029. Given the drop in the number of uninsured between 2013 and 2016, that’s a significant change of direction.
And, that assumes that Republican state attorneys general with help from the Trump administration won’t succeed in their attempt to end the ACA through the Texas v. Azar. lawsuit. More about that later.
Since 2017, the Trump administration and a Republican Congress, cut open enrollment periods, ended cost sharing reduction subsidies, defunded the reinsurance provision of the ACA, reduced exchange and navigator funding and introduced short-term, limited-benefit plans that cover very little but helped to destabilize the individual health insurance market. All of this contributed to higher health insurance premiums, especially in the individual market and helped to increase the number of uninsured and underinsured.
Toward the end of 2017 the Republican Congress, with support from the Trump administration, offered up a bill to repeal the ACA without any replacement. When that failed, they introduced the Graham-Cassidy bill which had a public approval of 24 percent at the time. Even though it failed it created huge uncertainty in the health care market.
In the 2017 tax cut bill, the Republican Congress and the Trump administration repealed the individual mandate provision of the ACA, further driving up premiums in the individual market and destabilizing that market’s risk pool. According to the CBO, the repeal of that provision is the single biggest factor driving their projections for the increase in the number of uninsured.
In 2019, the Trump administration proposed a budget that would have reduced funding for Medicare by $845 billion over 10 years, cut Medicaid by $200 billion, ended the Medicaid expansion program in thirty-seven states (including Colorado) and would have funded the remaining Medicaid program through an inadequately financed state block grant. Fortunately, it was never implemented.
That leaves us with the Texas v. Azar court case which could end up in the Trump-adjusted Supreme Court. If that effort succeeds, the ACA will end without replacement or even the hope of one.
A ruling against the ACA in some final iteration of Texas v. Azar would result in 20 million Americans losing their health insurance coverage according to an analysis from the Urban Institute. It would lower federal health care spending by $135 billion in the first year alone. Pre-existing condition exclusions or higher premium rates for those conditions could be re-introduced by insurance companies. As a point of reference, more than 130 million Americans have pre-existing health conditions.
Insurance companies could also reinstate annual and lifetime benefit caps. Medicaid expansion programs like the one in Colorado would be significantly damaged or destroyed. Premium assistance for low income families would likely end.
If Democrats really want to destroy health care as we know it, they should take lessons from the Trump administration, Republican members of Congress and Republican state attorneys general. They’ve been going at it for years. And as you can see, they keep trying.
Bob Semro of Glenwood Springs is a former health policy analyst for the Bell Policy Center, and a legislative and senior advocate. His column appears monthly in the Post Independent and at postindependent.com
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