How Republican plans will make us sicker

The Republican Party has a knack for keeping America sick.

In 1994, when virtually every other developed country had universal healthcare, Republicans and their medical-industrial complex allies used a flood of disinformation to kill President Bill Clinton’s healthcare reform bill.

For 16 long years after, Republicans blocked structural reform, with predictably grim results. By 2010, 49 million Americans lacked coverage. Medical bills accounted for 62 percent of U.S. bankruptcies (up from 8 percent in 1981). Tens of thousands of Americans a year died from a lack of healthcare coverage.

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Summarizing a 2010 Commonwealth Fund report, science writer Maggie Fox said that “Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system.”

Just months earlier, Democrats had overcome a Republican filibuster to pass the Affordable Care Act (ACA), but the law hadn’t taken effect yet.

Several frivolous court challenges and then-Sen. John McCain’s act of political courage later, the ACA has achieved a number of big things. They’ve made us healthier. And they’re worth listing individually:

• The ACA, colloquially known as Obamacare, currently provides healthcare to 40 million Americans.

• The U.S. now has its lowest uninsured rates in modern history. If not for state-level GOP resistance to Medicaid expansion, the number would be even higher — an estimated 2.3 million additional Americans would have healthcare coverage.

• The number of Americans under the age of 26 who receive coverage through their parents’ policies has more than doubled, according to the Centers for Disease Control and Prevention.

• Americans with pre-existing conditions (including “up to 86 percent of people ages 55 to 64” who are not yet Medicare-eligible) are no longer at the mercy of healthcare industry greed.

• Americans aren’t necessarily bound to toxic employers for their healthcare coverage, since they can sign up for the ACA if they leave a job with benefits. This is especially beneficial to the self-employed.

• Americans who experience traumatic, life-changing events won’t be gouged due to caps on annual out-of-pocket costs and the end of insurance company limits on payouts for a given patient.

• The ACA uses rate review to make insurance companies spend at least 80 percent of their budget on direct care, rather than on expenses which have no value to patients—marketing, advertising, profit margins, lavish CEO compensation and the inflated administrative costs that come with privatization and multiple billers.

Closing the health gap

Despite these big steps forward, four decades of Republican obstruction has ensured that the United States still has a long way to go before it catches up to its peers.

Unique among developed countries, the United States still fails to cover tens of millions of its citizens, which contributed to hundreds of thousands of deaths during the COVID pandemic.

Millions with employer-based coverage self-ration their care to avoid exorbitant co-pays and deductibles.

Relative to other developed countries, America still has far more medical bankruptcies, far higher infant mortality rates, far higher maternal mortality rates, and higher avoidable mortality rates.

Our fragmented healthcare system contributes to by far the highest rates of childhood deaths of any industrialized country, and our life expectancy is lower than some developing countries.

Because of GOP hostility to government price regulation (a component of all universal health systems), Americans continue to pay by far the most for healthcare and prescription drugs among our advanced economy peers.

To the extent he has been able — despite senators Joe Manchin and Kyrsten Sinema and unified Republican opposition — President Joe Biden has ameliorated these problems.

His American Rescue Plan Act increased ACA subsidies for millions, decreased income requirements for ACA eligibility, and lured additional states into Medicaid expansion with increased subsidies. Thanks to Biden, new ACA enrollments hit a record high this year.

The Inflation Reduction Act keeps ACA subsidies in place through 2025. It caps costs for insulin and other drugs covered under Part D of Medicare and will limit out-of-pocket prescription drug expenses to $2,000/year for Medicare beneficiaries in 2025. It also forces prescription drug companies to negotiate the costs of the 10 most expensive drugs (a number that will rise to 20 drugs annually.)

When blocked by Congress, Biden has used executive actions. Biden expanded postpartum Medicaid eligibility and open enrollment periods for the ACA and increased funding for navigators that assist Americans signing up for ACA coverage. He reformed Title X to extend family planning access to women who’d had it stripped away by the Trump Administration. He also fixed the “family glitch,” which kept family members of people with overpriced employer-based coverage from getting coverage through the ACA.

Biden also took a number of steps to shore up the Children’s Health Insurance Program (CHIP) and increase funding for the Maternal, Infant, and Early Childhood Home Visiting Program, which provides health benefits for Alaska Native and American Indian families and pays for itself many times over.

Your health is on the ballot

If given another term, and a Democratic Congress, Biden would continue improving the nation’s healthcare system, as reflected in his most recent budget.

Biden would expand care to the uninsured, improve coverage and lower drug costs in the CHIP program, Medicare and Medicaid.

He would try to extend ACA subsidies beyond 2025 and increase ACA subsidies to lower premiums.

He would raise the number of drugs Medicare negotiates to 50 annually, expand the $2,000 annual prescription drug cap to private plans and limit co-pays for generic drugs.

He would try to make Big Pharma pay rebates if the cost of a specific drug goes up more than inflation. His agenda also includes expanded home care services, improved access to mental health care, and increased research in women’s health.

He would continue to work on lowering maternal mortality rates and improving neonatal care. He could revive policies blocked by Congress during his first two years — such as a Medicare buy-in for Americans 50 and older and a national public option, which has lowered patient costs at the state level.

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By contrast, Donald Trump, the former president and presumptive 2024 Republican nominee, shows little interest in healthcare reform. His website is conspicuously light on healthcare policy. He rarely talks of it on the campaign trail.

In a nod to his old-and-white constituency, he promises to take on Big Pharma, but Biden is already doing this and congressional Republicans have actually considered a repeal of the pricing curbs that Biden established.

Trump’s site makes a vague statement about appointing a panel to review childhood illnesses, Washington-speak for kicking the can down the road.

His public statements offer mixed messages on the big issues. Would he try to repeal the Affordable Care Act? Would he protect Medicare, privatize it or cut funding? Would he maintain protections for people with pre-existing conditions or allow them to go without coverage by leading an effort to repeal the ACA, as he has threatened to do?

Given Trump’s prior record — his lack of clarity about future plans, his habit of lying consistently, the 88 felony counts pending against him across four separate criminal court cases — healthcare advocates have no good reason to trust him.

In fact, if Trump serves a second term with Republican majorities in Congress, the GOP would almost certainly make our healthcare system more expensive and less responsive to the average citizen’s needs.

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The recent House Republican Study Committee budget proposal slashes Medicaid, as did the House Republicans’ 2023 budget proposal. These cuts would be devastating to the poor, the disabled, special needs children, and millions of elderly Americans (Medicaid funds over half of America's long-term care.)

The United States, alone among its developed world peers, has 5 million children with no healthcare. GOP plans to gut Medicaid and the CHIP (Children’s Health Insurance Program) could cause millions more to lose coverage.

GOP repeal of the Affordable Care Act — which Republicans have attempted before and Trump and congressional Republicans remain open to — could have catastrophic consequences.

Up to 30 million Americans could lose their coverage, including many of our most vulnerable citizens. Up to 129 million Americans with pre-existing conditions could again be at the mercy of healthcare industry profiteers. Medical debt and bankruptcies could skyrocket. Millions of Americans could lose access to no-cost preventive services.

Women would bear the brunt of this, stuck with co-pays for (or simply foregoing) mammograms, cervical cancer screenings, pregnancy-related services, contraception, and Pap smears. Their children would lose vital pediatric immunizations.

Due to his unholy alliance with extreme-right, self-proclaimed Christians, Trump would likely exhume his policy to cut off funding for Planned Parenthood and other family planning organizations, thereby taking away birth control from millions of cash-strapped women and exacerbating America’s contraceptive desert crisis.

He would probably re-start his “final conscience rule,” which allows healthcare entities to deny reproductive healthcare to women for religious reasons.

His Justice Department would either support or (at best) present no legal challenges to red state abortion restrictions so ambiguously worded that they actually threaten certain forms of birth control.

He would pack the federal courts with anti-abortion judges such as Matthew Kacsmaryk, the Trump appointee who recently ruled to outlaw mifepristone, an FDA-approved medication used to end early-term pregnancies since 2000.

He would hamper fetal tissue research and undermine the National Institutes of Health and the Centers for Disease Control and Prevention. Again.

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In effect, Republicans could inflict the worst of all worlds: big steps backward toward the highly dysfunctional healthcare system we had pre-ACA, with its higher costs, fewer benefits, and more uninsured Americans. They would handcuff groundbreaking health research for American women.

We could expect less healthcare security, more anxiety about keeping our coverage (and our family’s coverage), more rationing due to prohibitive for-profit mark-ups, children not getting basic needs met, low-income disabled and elderly Americans going without and more back-alley abortions.

American lifespans, which already trail other highly developed nations by several years and have significantly regressed since their 2014 peak, will get shorter yet.

The 2024 presidential election will determine if the U.S. continues to gravitate toward the humane and effective healthcare models that exist everywhere else in the developed world or wins a race to the bottom with itself.

Dan Benbow has been an online political features writer since 2003. His work has appeared at Raw Story, the Miami Herald, the New York Daily News, Salon, Truthout and the Progressive. He is currently seeking representation for his first novel and can be reached at benbowauthor@gmail.com or followed @danbenbow on X.