Republican efforts sabotaged the Affordable Care Act

President Donald Trump, flanked by Vice President Mike Pence and Chief of Staff Reince Priebus, signs his first executive order on health care in January.
President Donald Trump, flanked by Vice President Mike Pence and Chief of Staff Reince Priebus, signs his first executive order on health care in January. AP

Obamacare is dead and the Republicans in office are guilty of premeditated murder. Since day one, they have done everything within their power to make it fail, even though it brought health care security to tens of millions of Americans. Many Republican-led states refused to set up their own state exchanges. They blocked public education and outreach efforts. They filed multiple lawsuits to block critical components of the Affordable Care Act, including the mandate. They even tried to block employer contributions for their own congressional staffers and then filed a lawsuit to try to prevent them from receiving subsidies on the exchange.

All this was an effort to decrease participation, particularly of younger, healthier people needed to balance out the older, sicker patients that would jump at the opportunity to finally have healthcare. If only sick people buy insurance, it is no longer insurance. It is expensive prepaid health care. That’s why any plan that covers pre-existing conditions has to have an individual mandate for coverage.

Republicans claim that a mandate takes away their “right” to not have insurance. I would accept that argument if the right to choose came with full responsibility for the consequences. But as long as hospitals are required to accept the uninsured and people can declare medical bankruptcy, coverage should be required. Otherwise we are all forced to pay for their right to choose through higher taxes and/or higher health care costs and insurance premiums.

After the ACA went into effect, Republicans not only blocked any attempt to improve it, they continued their all-out assault. While the 60+ GOP votes to repeal or gut the ACA were all show, their budgetary actions against the ACA drew blood. In 2014, Republicans slipped a provision into a large spending bill that dramatically cut payments promised during the first three years to protect insurers from unexpected losses from taking on high risk patients with unknown medical needs. In 2015, insurance companies were reimbursed only $400 million of the $2.9 billion promised by the ACA. They sued for payment and won in federal court but it is on appeal and many co-ops have already gone bankrupt. Reneging on those provisions in the ACA, along with lingering uncertainty of its future, was a major reason many insurance plans left the market last year and why premiums went up dramatically for those that stayed.

On Inauguration Day, Trump continued the assault by signing an executive order that implied that the IRS wasn’t going to enforce the penalty on the individual mandate. Then in the last week of ACA sign-ups, when the younger/healthier people critical to lower premiums tend to sign up, the Trump administration pulled prepaid TV and digital promotions for the ACA. Prior to the inauguration, enrollment was running ahead of last year, but with Trump’s intervention, the final enrollment was down by 400,000 over last year.

Regardless of what happens in the Senate, the House’s passage of the American Health Care Act dealt the final death blow to Obamacare. Insurance companies, already burned by a Congress hostile to Obamacare, are not going to commit to participation by the June deadline when no one has any idea what, if any, legislation will finally pass.

Yes, Obamacare is now in a death spiral, but it was wholly caused by Republican actions. We have to hold Republicans accountable for causing millions of Americans to lose insurance coverage. We must insist that they pass a replacement that provides coverage at least as good as Obamacare.

Their guarantee of “access” to health care just means you can’t be denied coverage. They won’t guarantee that you can afford a plan that covers your needs. Likewise, lower premiums don’t count if the plan doesn’t cover your problem or has low lifetime maximums. And we have to block the most obscene part of the House’s ACHA bill that takes healthcare from millions of low income Americans in order to give tax cuts to people that are thriving with their current tax rates. I will gladly support a tax cut … once all Americans are ensured affordable health care, clean air and water, a quality education, modern infrastructure and protection against the devastating effects of climate change.

As an optometrist who provides pro bono care for uninsured patients, I have witnessed their needless suffering from preventable and treatable diseases firsthand. There is no acceptable reason why all Americans can’t have the same health security that virtually every developed nation ensures to its citizens. We must demand nothing less from our elected representatives.

Marcia Dettloff is a Cary optometrist.