The Trump administration has returned with renewed vigor to its war against the Affordable Care Act. If if it succeeds, the damage would touch almost all of us.
The latest line of attack is to side with the plaintiffs in a suit challenging the law, urging an appeals court to strike down all of the ACA as unconstitutional. The administration had originally argued that only the protections for individuals with preexisting medical conditions should be tossed out.
If the administration’s new stance were to prevail, almost everyone would feel the catastrophic effects. Its original position was destructive enough in pulling health insurance from millions of people who are sick. Its new position would wreak havoc throughout most of American health care.
Among the biggest losers would be millions of adult children kicked off their parents’ coverage, hundreds of hospital partnerships known as accountable care organizations forced to close, millions of seniors again facing the infamous “donut hole” gaps in Medicare prescription coverage, and thousands of patients unable to buy cheaper generic versions of expensive specialty drugs. And, of course, millions of poor and disabled patients who would lose access to health care in states that expanded Medicaid.
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The administration’s action doesn’t even have a coherent legal rationale. Its new argument defies both law and logic.
It argues that because the Supreme Court upheld the law’s mandate to obtain insurance as a tax, repeal of the tax by Congress in 2017 eliminated its constitutional basis. And because the mandate is central to the law’s overall scheme, it cannot be severed from the other provisions and everything must go.
This argument makes little sense. The Supreme Court ruled that as a tax, individuals are in full compliance whether they choose to pay the tax or to obtain coverage. With the amount of the tax now set at zero, everyone has automatically complied. In other words, the mandate as a compulsion to obtain coverage has disappeared. How can it be unconstitutional if it no longer exists?
Even if the now nonexistent mandate were found to be unconstitutional, Congress has expressed a clear desire to retain the rest of the law without it. Just a few months before voting to eliminate the tax, it rejected proposals to repeal the law in its entirety. If it had wanted all of the law to fall, it would have voted in favor of full repeal, not against it. In fact, the ACA’s insurance exchanges are continuing to function quite well without the mandate, providing coverage to millions of people.
Might anyone benefit from the new assault on the ACA? It’s hard to imagine who they would be.
Certainly not the millions of patients who would lose access to health coverage and pay higher prices for drugs. And certainly not the hospitals whose partnerships to improve the quality and efficiency of care would dissolve, the insurance companies that would see markets for individual policies disappear, or the drug companies whose generic specialty drugs could no longer be sold.
And probably not Trump’s fellow Republicans, who could face voters next year as the anti-health care party.
Trump can’t seem to keep the ACA out of his crosshairs, and his scorched earth policy could burn everyone. He might not care — but millions of Americans should.