Setting a building on fire and then “rescuing” its inhabitants does not make one a hero—quite the opposite.
Thwarting the intent of a law by refusing to enforce it and then using that action to further undermine the law does not make one a skilled policymaker representing the will of the people—quite the opposite.
But that is what the president and his attorney general have done in supporting a lawsuit that would eliminate the Affordable Care Act’s requirement to cover pre-existing medical conditions, leaving those who are sick and uninsured without coverage options. The suit was filed by several conservative states and the ACA is being defended against by a group of heavily Democratic states.
Actually, the administration is going much further, endorsing the declaration of the entire ACA as unconstitutional because the health insurance mandate (upheld famously by the Supreme Court in 2012) is so central to the law.
The conservative states’ lawsuit argues that if the there are no penalties connected to the mandate (a provision Republicans included in the recently passed tax bill), then there is no incentive for people to seek insurance until they are already sick—an unfair and expensive situation for insurers.
The lawsuit and the attorney general’s brief in support of it is the latest salvo from the Trump Administration and congressional leaders. It is also illustrative of the approach both of those entities have taken toward alleged healthcare reform.
-After the passage of the ACA, Republican congressional leaders and most of the party’s rank-and-file passed straight-up repeal bills for seven years running, knowing they could make political hay amid repeated presidential vetoes.
-Donald Trump and most Republican candidates in 2016 campaigned on a “repeal and replace” position on the ACA and healthcare reform and—by-and-large—won.
-After gaining control of the presidency, majorities in both chambers of Congress, the Supreme Court, most state governorships and state legislative majorities, Republicans faced their most dreaded enemy—one another. With seven years to come up with a replacement plan, congressional leaders spent months tearing one another apart without coming up with a replacement for Obamacare.
-After failing at healthcare reform, congressional Republicans used a budget bill as a vehicle to strip enforcement of the financial penalties attached to the ACA’s mandate that all individuals buy health insurance.
That leads us to the most recent development, the lawsuit challenging the constitutionality of requiring insurers to cover pre-existing medical conditions. This move, as have past initiatives features no “replace,” only “repeal,” which leaves the United States with the most embarrassingly ineffective healthcare coverage environment in the free world and hurts the nation’s most vulnerable populations most.
This chain of events is most confounding because it occurs as public support for the ACA is rising and on the heels of Republican replacement plans that garnered widely reported support numbers of 17 percent.
Amid all of the smoke and debris, Republican leaders have consistently claimed that the main problem with the ACA and the current insurance environment is steadily rising premiums that put health insurance out of reach for middle-class people. Conservative policy wonk Sen. Ted Cruz in town hall meetings cited examples of small business people who could not afford to offer health insurance to their workers because of rising premiums that many who, while not wealthy, exceeded the income limits for federal premium subsidies.
Ironically, the lawsuit to end pre-existing condition coverage renders the affordability issue moot. Insurers can simply refuse to offer insurance to an individual—at any price. History suggests that is exactly what many will do.
It will be interesting to see how those who filed and those who support this lawsuit explain how creating more uninsured people and excluding the sickest among us from coverage is a good thing.
By the way, we’re still waiting for that replacement plan.