With less than a week before Donald Trump’s swearing in as president of the United States, and the newly elected congress now fully seated, Republican lawmakers are set to fulfill a campaign promise: the repeal and replacement of the Affordable Care Act (ACA), commonly known as Obamacare. Although the congressional Republicans passed a similar package in 2015 – one that was vetoed by President Obama – it’s uncertain what new laws are to be enacted.
Inasmuch as the ACA has been in effect since 2010, resulting in an estimated 20 million reduction in the number of uninsured persons, any new rules not making some provision for this fact will cause irreparable harm to many. In addition, if the currently operating set of subsidies to Americans with lower incomes, which help pay their premiums and deductibles, is done away with, how will those affected be able to access affordable health care? And finally, elimination of the provisions of ACA which extended Medicaid to include coverage to anyone earning less than $16,000 if single, or $33,000 for a family of four, will prove disastrous if simply eliminated.
It’s clear the Republican leadership is aware of the complexities involved. House Speaker Paul D. Ryan vowed “We’re not going to swap one 2,700-page monstrosity for another.” However, in closed-door meetings over the past two weeks, Republican legislators have expressed concern that no simple solutions are readily apparent and that the process of crafting a new set of workable laws could drag on interminably.
Let me offer an analysis and a prediction. Basic to the problem is the reality first-rate medical care in this country is unaffordable for most citizens, with 47 percent of Americans unable to come up with even $400 to cover an emergency room visit. Of even greater concern is the fact our nation now provides assistance to over 109 million welfare recipients. Included among the benefits provided is $74.1 billion to roughly 46.5 million persons on the Supplemental Nutrition Assistance Program (previously known as food stamps). It’s for these reasons I believe there can be no governmental program which provides health care to a meaningful percentage of the less affluent among us without unfairly targeting the income and assets of the vast mass of middle-class, middle-income Americans. Whatever program the Republicans eventually enact in response to the unpopularity of Obamacare will prove to be equally unpopular.