Affordable Care Act, Barack Obama, Donald Trump — December 30, 2016 at 6:23 pm

If the GOP guts Obamacare funding with tax breaks for the rich, it’s dead


Any vote to repeal is a vote to uninsure millions and sentence America’s sick to untold misery

Add America’s sick to the top of the list of those who will most be directly threatened by Donald Trump and the GOP.

If the next Republican Congress guts the funding for the Affordable Care Act next month, which it almost all but certainly will with big tax breaks for millionaires, Obamacare is dead and the damage will reverberate for years, punishing the sick the vulnerable.

This doesn’t have to happen — three Republican Senators can stop it.

But if they don’t, it will be a diaster news for the millions of Americans who’ve suffered from a serious illness and benefit from the law’s historic protections that ended maximum caps on insurance coverage for everyone whether or not they get coverage through their employer and discrimination against the sick. And this will be true even if full repeal of the law is delayed for as long as four years, which some Republicans are actually proposing.

Obviously if Obamacare were so terrible and it were really collapsing, the GOP wouldn’t think preserving it for years is the key to winning reelection. And this ruse also reveals that they know that they can’t promise to return the health care market of 2009.

People will want the “something terrific” Trump promised and there will be no money to pay for it, especially will the boodles of giveaways for the rich that the GOP has planned. And we know Republicans will never vote to replace this taxes on the rich — because Republicans will never vote to tax the rich, or for any new taxes in general.

Without the funding now in place, there will be no way to maintain coverage for the tens of millions of Americans who have gained it in the last two years. And there will be no way, despite Republican promises to the contrary to make our health care system work for the sick, who will be forced to maintain coverage that will likely cap out early into a chronic conditions.

This will be a disaster and Democrats need to prepare now for this outcome, instead of baking on pipe dreams about being able to convince Trump to use his “deal making” skills to preserve the amazing things Obamacare has accomplished.

“Indeed, as soon as the GOP takes on the healthcare system –with repeal of the ACA — we should think of it as a new system: GOP-Care,” Adam W. Gafney, an instructor at Harvard Medical School, tweeted.

When you take on “reforming” the health care system, you don’t just own it. It owns you. Ask the Democrats who are no longer in Congress about that.

All of the fictional stories about the ACA — millions people threatened with losing care, coverage and doctors as insurance markets collapse — will likely be true about GOP-Care. And just as Republicans can’t promise to take us back to 2009, Democrats won’t be able to run on just reinstating Obamacare to its 2016 shape, which was a massive leap forward but suffered for its compromises and sometimes baffling structure.

Gaffney’s solution is single-payer, which he notes is more popular than the ACA as it is.

Greg Dworkin — a doctor, Daily Kos editor and Twitter’s most prodigious Storifier — generally agrees with Gaffney.

He offers this formula:

1. Preserve Medicare.
2. Extend it to everyone.
3. Keep it simple.

Greg recognizes that this won’t be easy for the same reason that the fight over the confirmation of Trump’s pick for Secretary of Health and Human Services Tom Price won’t be easy. Price is a doctor who quickly won the endorsement of the American Medical Association, despite his desire to repeal Obamacare, privatize Medicare and generally immiserate seniors.

Expanding Medicare will split doctors the way Price’s endorsement has — with pediatricians generally backing single payer and specialists backing Price and the “free market” medicine that allows surgeons to cash in without restraint.

There may be no one outside of the Obama Administration or academia who has though more about Obamacare’s successes and limitations than’s Charles Gaba who agrees with Gaffney “in theory, but in practice it’s still very tricky.”

What’s so tricky about just giving everyone Medicare?

Well, some 80 percent of Americans are covered by Medicare, Medicaid or group coverage mostly from their employer — and they like it that way.

But with Republicans certain to attack Obamacare and Medicaid and then eventually Medicare, Democrats will be forced to respond.

“If the GOP really DOES botch one or more of those up anyway, then yeah, it makes sense to start there,” Charles says.

Three things are undeniably true about the health care system:

1. We already pay for each other’s health insurance — even people who get it from their jobs through billions tax breaks. We just pay for it in the dumbest way possible that leaves millions uninsured while paying more both per capita and in total cost than any country on Earth, by far.
2. Republicans are about to break a system in a way that devastate the sick — sooner or later.
3. Democrats need to respond with a solution that’s simpler and more defensible than Obamacare.

So let’s start talking about what that solution should look like.

[CC image via LaDawna Howard |]