Writing Tuesday ahead of the first presidential debate, Brownstein noted that Republicans have been demanding the repeal and replacement of Obamacare for more than ten years, but at no time have they propose an alternative to the law. It was the main reason that Sen. John McCain (R-AZ) refused to support the repeal of the law.
“While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens," McCain said after giving a "thumbs down" to the bill.
For five years Trump too has been promising a healthcare plan. Last week, he went so far as to host a huge press conference announcing an executive order that would deliver things Obamacare already passed in the law. Trump also claimed to be giving Americans telemedicine and inventing HIPPA laws, which also already exist.
"Every alternative to the Affordable Care Act that Republicans have offered relies on the same strategy—retrenching the many ACA provisions that require greater risk and cost-sharing between healthy and sick Americans—to lower the cost of insurance for healthier consumers," wrote Brownstein. "Put another way: Reducing protections for patients with greater health needs isn’t a bug in the GOP plans; it’s a key feature."
“Lowering premiums was a big theme of the Republican effort to repeal and replace the ACA, and central to their idea of lowering premiums was rolling back protections for people with preexisting conditions,” Brownstein quoted Larry Levitt, at the Kaiser Family Foundation.
Then there's the matter of Trump's failed COVID-19 response that killed thousands of Americans because the president didn't want to put the country in quarantine.
Further, there's a concern that Trump's new Supreme Court nominee, Amy Coney Barrett, will put the final nail in the coffin of the Affordable Care Act.
Trump and the GOP promises that they'll protect people with preexisting conditions if the High Court overturns the law, but there's no bill from the GOP to protect anyone if that happens. Trump seems to believe that his executive order passed an edict across the country, but such an order is toothless and did nothing other than advocate support for covering preexisting conditions. Support doesn't make a law.
“The ACA has far exceeded expectations in protecting people with preexisting conditions,” said Levitt. Doing so, however, means higher premiums. The idea was that if the individual mandate was in place, it would introduce healthy people into the market place and help keep costs low for everyone. When the mandate was removed by Republicans, healthy people stopped buying insurance, sending premiums soaring.
“Democrats certainly don’t like to talk about the trade-offs that were involved in the ACA,” Levitt said. “But covering people with preexisting conditions isn’t free. It had to come from somewhere, and it came from higher premiums from people who are younger and healthier.”
Trump doesn't seem to fully grasp the specifics about the healthcare law, nor does he seem to have a grasp on a plan he would introduce to fix any problems from the ACA. The two proposals that Republicans tried to create destroyed cost-sharing in Obamacare. Instead, they own method.
“Essentially, the [Republican] view is, your premiums should reflect the risk you pose to the insurer, and insurers should be able to assess that risk and then set a rate accordingly,” says Georgetown Professor Sabrina Corlette, at the Center on Health Insurance Reforms. “I think the problem with that is, ultimately, it means older, sicker folks, women of childbearing age, will pay more under that system.”
The plan that Trump ultimately supported, Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) proposal that eliminated any cost-sharing and allowed insurance companies to charge older customers hefty sums for health insurance.
"Each of those provisions would have advanced the GOP’s goal of reducing premiums for the healthy, but at the price of making coverage more expensive or unavailable for Americans with greater health needs," wrote Brownstein.
After spending ten years complaining about the ACA and bashing Obama with tea party rallies non-stop. Republicans ushered in a 33-person gain in the House after the 2010 election on a campaign against the ACA law. Since then, however, the tide has turned and while Americans recognize that there are problems with the law, they largely prefer the things they got out of it.
A September poll showed that former Vice President Joe Biden far more than Trump and the GOP to fix the ACA.
Meanwhile, "Trump and other Republicans are still resolutely denying the inescapable reality that their proposals will increase costs and reduce access for the sick, not as an unintended consequence, but as the central lever to lower premiums for the healthy," Brownstein noted. "Those Republican denials haven’t convinced most voters."
Read his full editorial at The Atlantic.
