Opinion
Voting G.O.P. Means Voting Against Health Care
The death of Ruth Bader Ginsburg has only raised the
stakes.
By Paul
Krugman
Opinion
Columnist
Sept. 21,
2020
If you or
someone you care about are among the more than 50 million Americans suffering
from pre-existing medical conditions, you should be aware that the stakes in
this year’s election go beyond abstract things like, say, the survival of
American democracy. They’re also personal. If Donald Trump is re-elected, you
will lose the protection you’ve had since the Affordable Care Act went into
effect almost seven years ago.
The death
of Ruth Bader Ginsburg has made this even more obvious. In fact, it’s now possible
that coverage of pre-existing conditions will be stripped away even if Trump
loses to Joe Biden, unless Democrats also take the Senate and are prepared to
play serious hardball. But health care was always on the line.
Now, Trump
denies this; like almost every other politician in his party, he keeps
insisting that he has a plan to protect Americans with pre-existing conditions.
But he and they are lying. And no, that’s not too strong a term.
On Trump:
In early August he promised that he would soon release a great health care plan
to replace Obamacare, probably by the end of the month. We’ve heard nothing
since, which isn’t surprising, since he has made and broken similar promises
many times.
It’s safe to
assume that there was never any basis for these promises; there is not now and
has never been a secret skunk works in the executive branch devising a
brilliant new health plan.
Among other
things, Trump administration officials have been too busy botching their
response to the coronavirus. Did I mention that, as we pass the 200,000 deaths
mark, cases appear to be rising again?
But we
would know that Republicans are lying about pre-existing conditions even if
Trump hadn’t established such a remarkable record of serial dishonesty. For the
fundamental logic of health policy says that if you want to protect
pre-existing conditions, you either have to have the government provide health
insurance directly, as it does with Medicare and Medicaid, or use a combination
of strict regulation and subsidies to induce private insurers to offer
coverage.
And if you
do try to rely on private insurers, the necessary system of regulation and
subsidies will, inevitably, look a lot like Obamacare.
To protect
people with pre-existing conditions, you must prevent insurers from
discriminating based on medical history — which includes imposing minimum
standards, so that they can’t offer cheap, minimalist plans that appeal only to
the healthy while charging exorbitant premiums on plans that help those who
really need care.
You also
need to induce healthy people to sign up for coverage, which means providing
financial incentives to do so — especially generous subsidies to working-class
adults.
In other
words, you need a system very similar to the one America has had since 2014,
when the Affordable Care Act went fully into effect. That system can and should
be made better, but this would require spending more, not less — which is, in
fact, what Biden is proposing.
None of
this is news. The G.O.P.’s inability to come up with a superior alternative to
Obamacare was put on stark display in 2017, when Republicans came very close to
enacting their own health care plan.
At the
time, the Congressional Budget Office estimated that the legislation would
cause 32 million Americans to lose health insurance — and even that number
understated the likely damage, because those still buying insurance would have
faced sharply higher premiums.
How does
Ginsburg’s death affect the health care outlook? The Trump administration is
backing a lawsuit, now before the Supreme Court, claiming that a fairly minor
provision in the 2017 tax cut somehow rendered the whole Affordable Care Act
unconstitutional. It’s a ludicrous argument — but Republican judges in lower
courts have backed it anyway, and a court without Ginsburg is more likely to
let partisanship override any pretense of respect for logic.
The odds
that the court will destroy Obamacare, and with it protection for pre-existing
conditions, will obviously go up if Trump is able to install a right-wing
partisan to replace Ginsburg. And even if this particular attempt to take away
health insurance from millions falls short, it’s a safe bet that a court with a
6-3 conservative majority will find some excuse to undermine the protections
Americans have come to count on.
Indeed,
such a court might well try to strike down Obamacare even if Trump loses.
So are
Americans with pre-existing conditions doomed? Not if Democrats take the Senate
as well as the White House. If they do that, they’ll be in a position to
quickly reinstate an improved version of Obamacare soon after Biden is sworn
in.
And yes,
adding seats to the court will have to be on the table. Spare me talk about
norms. Between Trump’s lawlessness and Mitch McConnell’s naked power plays,
Republicans have forfeited any right to complain if Democrats legally act to
protect the well-being of millions of Americans.
So once
again, if you or someone you care about has a pre-existing condition, be aware
that your fate is very much on the ballot this year.
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