Trump Renews Fight to Repeal Affordable Care Act

President Trump is again focusing on one of his promises during the 2016 campaign: to abolish the Affordable Care Act.

The legislation, commonly known as Obamacare, greatly expanded low-income and working-class Americans’ eligibility for Medicaid. More than 20 million additional people are now getting health insurance from private companies through the federal program.

Democrats vow to resist the administration’s efforts to end the ACA. Most of them favor making it even easier to qualify for the coverage, and some want to enact a “Medicare for all” system guaranteeing health insurance for everyone.

President Trump is again focusing on one of his promises during the 2016 campaign: to abolish the Affordable Care Act.

The legislation, commonly known as Obamacare, greatly expanded low-income and working-class Americans’ eligibility for Medicaid. More than 20 million additional people are now getting health insurance from private companies through the federal program.

Democrats vow to resist the administration’s efforts to end the ACA. Most of them favor making it even easier to qualify for the coverage, and some want to enact a “Medicare for all” system guaranteeing health insurance for everyone.

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Trump Renews Fight to Repeal Affordable Care Act

-By Jim Owen

President Trump is again focusing on one of his promises during the 2016 campaign: to abolish the Affordable Care Act.

The legislation, commonly known as Obamacare, greatly expanded low-income and working-class Americans’ eligibility for  Medicaid. More than 20 million additional people are now getting health insurance from private companies through the federal program.

Democrats vow to resist the administration’s efforts to end the ACA. Most of them favor making it even easier to qualify for the coverage, and some want to enact a “Medicare for all” system guaranteeing health insurance for everyone.

Battle in the Courts

In late March, Justice Department officials called for repealing the ACA. They filed a motion in the U.S. appellate court in New Orleans stating that federal District Judge Reed O’Connor was right in December when he decided the law violates the Constitution.

The Texas judge ruled that the ACA became illegal with last year’s passage of a tax bill which eliminated the individual mandate – a provision that required everyone to obtain health insurance or incur a tax penalty.

O’Connor agreed with Republican officeholders in 20 states who were the plaintiffs in the case. The lawsuit claimed that without the individual mandate, the ACA is unconstitutional because it no longer falls under tax regulations.

There was some irony in the argument. Since the inception of Obamacare, Republicans have denounced the individual mandate. Conservatives, and even some liberals, consider the requirement an example of government overreach.

They claim that Congress has no right to force people to buy insurance. In 2012, the Supreme Court approved the mandate because it was essentially a tax that lawmakers are empowered to enact.

The court system appears to be Trump’s only route for abolishing the Affordable Care Act. Due to the Democratic majority in the House of Representatives, any attempt to gut the law is almost certain to fail.

The political dynamics may change if Republicans retake control of the House in the 2020 elections. However, recent polling has indicated that the GOP is in danger of losing its majority in the Senate, as well.

Provisions of the ACA

Despite Republican opposition, Congress approved Obamacare in early 2010. Obama signed the measure into law, bringing about the biggest changes in the country’s health-care system since the creation of Medicare and Medicaid in 1965.

Liberal Democrats sought to completely overhaul the system by having the government provide health insurance. Following months of heated debate, lawmakers maintained the private insurance system – with government subsidies and regulations.

They rejected a “public option” that would have allowed Americans to purchase health insurance from the government rather a private company. Those who got their coverage from employers were allowed to keep those policies. But the ACA imposed requirements on individuals, employers, health-care firms and the insurance industry.

The goal was to expand access to health care, lower the cost of medical treatment and improve the delivery of care. The law permitted people to continue receiving coverage under their parents’ policies until the age of 26. Companies with 50 or more employees had to offer comprehensive insurance plans that their workers could afford.

Unemployed people, as well as those employed in small businesses, were subject to the individual mandate. They could buy insurance through either a state-level exchange or the federal insurance “marketplace.” Everyone under the age of 65 whose incomes were below 133 percent of the official poverty line are eligible for the lower-cost coverage.

Some states, notably those with conservative governors, turned down federal funding to set up the exchanges. Their opposition to the ACA, on constitutional grounds, resulted in the low-income residents of certain states remaining uninsured.

The law prohibited insurance companies from denying coverage, or raising premiums, on customers with pre-existing medical conditions. All policies had to include preventive services free of charge to individuals. In addition, the ACA demanded more efficiently operated services and the use of advanced health-information technology. The law rewarded providers with incentives for reducing waste and fraud while improving access to care.

In a review of the law five years after it went into effect, the National Institutes of Health issued a review of the “immediate and long-term effects.” The government agency cited “peer-reviewed scholarly journals” that had published analyses of the ACA, as well as information the government compiled.

The review confirmed that Medicaid expansion, federal subsidies and health-insurance exchanges (through which individuals sign up for coverage) had enabled millions of Americans to obtain insurance.

However, the NIH found that health care was still too expensive for many people to afford. Officials wrote that income and race continued to play significant roles in determining whether an individual was covered.

Pros of the ACA

Proponents of the Affordable Care Act criticize Trump and express outrage that the United States is the only industrialized country which does not guarantee health care for all its citizens. They advocate a system similar to those in Canada and Europe, where governments have replaced insurance companies and regulated all aspects of health care. Obamacare supporters believe the government should ensure coverage for more, not fewer, people.

Democrats warn that if the ACA is repealed, tens of millions of Americans will lose their insurance coverage. That would not only endanger people’s health; it also would cause more workplace absences and burden emergency services. Lacking preventive and early care, medical conditions could worsen to the point that treatments become much more expensive.

The ACA is the only federal statute preventing insurers from dropping coverage for customers with pre-existing conditions. Abolition of the law would deprive hospitals and clinics of the federal funding they rely upon to remain open. Rural hospitals across the country are already shutting down due to financial problems.

Forbes cautioned that getting rid of Obamacare also would reverse policy changes the Department of Health and Human Services has made the past two years. The agency is conducing demonstration projects in anticipation of bringing down the cost of prescription drugs – a major problem for low-income Americans.

Cons of the ACA

For Trump and others, their opposition to the Affordable Care Act centers on two primary concerns: the cost of the system and the role of government.

The law brought about a nearly $2 trillion hike in annual federal spending on health care, though cuts in the Medicare budget are covering some of expense. One projection estimates that the cost of Medicaid expansion (including the subsidies beneficiaries receive to help them afford insurance) will total more than $1.8 trillion between 2015 and 2025.

Conservatives note that the spending is adding to the federal deficit, which already has soared to record levels. The budget shortfall threatens the stability of the nation’s economy.

The ACA decreases payments to companies providing services to Medicare patients, which is designed to partially compensate for the cost of subsidizing coverage for others. The payment cuts are expected to amount to more than $700 billion from 2013 to 2022. The Heritage Foundation predicted that as a result, elderly Americans will find it more difficult to obtain quality medical services.

Another downside to the law is that millions of people have lost, or are in danger of losing, the health insurance they get from the private sector. The ACA has caused problems in for-profit insurance markets by forcing companies to provide additional benefits.

Four million fewer Americans reportedly were enrolled in employer-funded insurance plans in 2014 than the previous year. That canceled out more than 60 percent of the increase in insurance coverage resulting from Obamacare.

Huge numbers of people have been denied the right to see doctors of their choice. They must choose an ACA-approved provider, a requirement that the government insists is necessary to control costs. A study by consultants at McKinsey and Co. discovered that almost half the insurance exchanges have “narrowed” doctor choices.

The law has not brought down the overall expense of health care in the United States, as Obama and other Democrats pledged it would. In 2014, the first year of the individual and employer mandates, many exchange customers were paying more than they did for private insurance the previous year. Premiums for employer-provided plans continue to rise, as well.

The ACA imposes 18 tax increases, penalties and fees that were projected to give the government more than $770 billion between 2013 and 2022. Among the levies are taxes on medical devices and insurance companies.

Beyond the financial considerations, Obamacare offends conservatives because it is a rejection of the market-based system. Most Republicans see the law as a threat to the concept of supply and demand, as well as an expansion of government power.

The problem is shaping up to be a major issue in the 2020 congressional and presidential elections. Democratic candidates are telling their party’s voters that they will protect Obamacare and go even further.

Several White House hopefuls are espousing Medicare for all. They include Sen. Bernie Sanders of Vermont, a political independent who describes himself as a democratic socialist. Universal health care also is the subject of legislation recently introduced in Congress.

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