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Dude, Where’s Our Health Care Now? (An Update)

For months, I’ve been warning everyone to limit their time on the “poller coaster”, take the TV pundits’ on-air theorizing with massive grains of salt, and focus on what truly matters over the glitzy “insta-scandals” that tend to fade after a handful of 24-hour news cycles. And yes, sometimes I must remind myself to do a better job of taking my own advice.

So today, we’re returning to the evergreen issue of health care. Before we go into further detail on what’s being debated on the campaign trail, we first need to talk about the current law that the current administration is trying to derail.

Let’s remember how we got here
Photo by Jeff Kubina, licensed under Creative Commons, and made available by Wikimedia

Back in March, we took a closer look at President Donald Trump’s renewed effort to repeal the Affordable Care Act (ACA, or Obamacare) via the federal courts. If a majority of U.S. Supreme Court Justices agree with the White House, that means a number of policies that have gained popularity and the perception as settled law, such as Medicaid expansion, mental health parity, and protections for patients with pre-existing conditions, will suddenly be overturned by the nation’s highest court.

Thus far, it appears unlikely that the Supreme Court will suddenly do they have previously opted not to do in the last seven years. But considering the Supreme Court’s right-wing majority’s growing deference to Trump on other issues, we can’t take anything for granted.

Research has shown that health insurance coverage for at least 243,000 Nevadans and at least $643 million in federal funding for the state will be endangered by ACA repeal. Yet even though Trump has yet to succeed in repealing the ACA through Congress or the courts, he’s already succeeded in wreaking enough havoc in the health care system to inflict real damage to the nation’s physical and financial well-being.

Before we talk about where we may or may not go next, we have to understand where we are now
Photo by Andrew Davey

For the first time since the ACA became law in 2010, the Census Bureau reported that the number of uninsured Americans ticked up to 27.5 million (or 8.5% of the population) last year from 25.6 million in 2017. Between the 2017 tax law’s elimination of the ACA’s mandate that all individuals have health insurance, the reintroduction and expanded availability of “junk insurance” plans that don’t comply with ACA coverage standards, and administrative rules changes that are meant to further destabilize the insurance market, it should be no surprise that Trump’s efforts to disrupt the system are finally having an effect.

On one hand, Nevada has taken a few steps to insulate our residents from Trump’s havoc-wreaking ways, such as moving Nevada Health Link (the state’s ACA insurance exchange) back to its own in-state portal and the Legislature passing AB 170 earlier this year to codify the ACA’s patient protections into state law. However as long as the White House continues its threats to blow up the entire ACA, programs like Medicaid expansion that have brought down the state’s uninsured rate from 21.7% in 2013 to 14% in 2017 will continue to be in jeopardy.

Photo by Andrew Davey

There’s been plenty of talk this year about where the 2020 Democratic presidential candidates stand on health care, and we will soon take a closer look at their plans. And yes, we will compare and contrast the expansive “Medicare for All” single-payer approach favored by Senators Bernie Sanders (I-Vermont) and Elizabeth Warren (D-Massachusetts) with the more modest reforms favored by their more moderate rivals. But first, we needed to examine the current state of the nation’s health care law to understand where we are now and what challenges lie ahead in fixing the system.

Oh, and one more thing: Considering how dead-set Donald Trump and Congressional Republicans are on repealing the ACA entirely, and how previous attempts at bipartisan legislation to fix the ACA were nixed in 2017 and 2018, the chance at any kind of bipartisan “grand bargain” to strengthen Obamacare any time soon is probably somewhere between slim and none. If anything, it looks like history is more likely to repeat itself in Democrats having to “go it alone” on health care, regardless of whether they ultimately decide to pursue modest ACA fixes or a more robust single-payer plan.

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