ACA a lasting legacy for Obama

Obama AP

Congressional town hall meetings have again become rough terrain. National leaders are heaped with scorn. Some cancel sessions, others escape unceremoniously, at least one California congressman had to be escorted out by the cops. Democrats, chastised in 2010, perhaps smile quietly as folks like Joni Ernst, Chuck Grassley, Jason Chaffetz, Tom Cotton, Mitch McConnell and even Jim Jordan, founder of the Freedom Caucus, are mercilessly upbraided.

Aversion to the repeal of Obamacare seems the topic of choice. Apparently if you take health care away from tens of millions of people they get annoyed. Who knew? Sean Spicer explained that the “so-called angry crowds” were “paid protesters.” Given their numbers, it must be a full-employment plan.

North Carolina Republicans have opted for the disappearing act. Sen. Richard Burr has important work making phone calls defending the Trump-Putin bromance. Thom Tillis has decided that call-in and Facebook conversations are now the way to go, since “some attend town halls just to create media spectacles.” And he apparently can’t find a “facility” sufficiently spacious to accommodate his critics. Both Burr and Tillis have seen large constituent protests demanding town hall meetings.

George Holding has lost affection for his regular Tuesday gatherings, suggesting forums “with protesters are not real town halls.” Robert Pittenger has discovered telephone sessions are “more inclusive.” His commitment to “inclusion,” of course, last surfaced when he announced that Charlotte demonstrators protesting the police killing of Keith Lamont Scott “hate white people because white people are successful and they’re not.” That’s Pittenger – inclusion, all day, every day.

The Congressional Budget Office, the Urban Institute, the Robert Wood Foundation, the Commonwealth Fund and the Economic Policy Institute each report that the repeal of the Affordable Care Act will result in the loss of health care coverage for between 24 and 30 million Americans. Two-thirds of those excluded will have only a high school education or less. President Trump told the Conservative Political Action Conference last week that “Obamacare covers very few people.” He lies when he draws breath.

EPI’s recent study concluded that 1,025,00 North Carolinians are now poised to lose their health insurance, raising the percentage of uninsured by 90 percent. That will mean thousands of low income Tar Heels will die prematurely. The largest toll will be taken on small town and rural residents. A cool day’s work in the war on poor people.

At bottom, the dispute over Obamacare turns on how we choose to structure, allocate and pay for health care services in the United States. For decades, we’ve spent far more, per capita, than any nation in the world. We have also left tremendously higher percentages of our residents outside the system, uncovered, in the shadows.

The Peter Peterson Foundation concluded last year that our per capita health care spending is more than twice the average of the other advanced, wealthy nations. But because, unlike the rest, we fail to provide universal coverage, we also have the lowest life expectancy, the highest infant mortality and the highest rate of chronic disease. We spend the most, cover the fewest and have the worst outcomes, by far.

I was surprised to learn that we also spend more on health care from government-imposed, taxpayer-based resources than any other nation. Medicare, Medicaid and the Veterans Administration, after all, constitute 48 percent of all national health care expenditures. As Dr. David Himmelstein puts it, Americans already foot the bill “for national health insurance, they just don’t get it.” We pay a tragically high price for our commitment to inequality.

The Affordable Care Act is surely flawed. But it does push back, powerfully, against our singular, equality-disparaging record of exclusion. In 2010, nearly 50 million Americans were uninsured, some 16 percent. By 2016, the percentage had been cut almost in half, to 8.6 percent – the lowest figure in American history. Barack Obama hadn’t cured our health care challenges. Far from it. But he had pressed boldly to move the United States toward the company of civilized nations, assuring fundamental health care services for the entire residency. That’s no small legacy.

And, of course, Obamacare is famously insecure – as Republicans in North Carolina and in Washington press to dismember it, to erase its rapid steps forward. I am not certain that, temporarily, it won’t be gutted. After all, we have a president who just blathered: “Nobody knew health care could be so complicated.” But millions of Americans, and more than a million Tar Heels, have been treated to the security and dignity of what most of the advanced world deems a fundamental human right. I doubt that Republicans, long term, can convince them they deserve to be shoved back under the bus. Obama may have permanently closed that door. And what an achievement history will reveal that step to be. It is another robust reason, no doubt, to hate Obama with unrelenting passion. But I trust he sleeps well.

Gene Nichol is Boyd Tinsley distinguished professor of law at the University of North Carolina.