Number 18 in a series

From ABC World News Tonight with David Muir, “This is what winning looks like!”

Amazing! If this is what winning looks like, then I would hate to see what losing looks like.

President Trump spoke these words while standing before a group of Air Force Academy cadets in the White House rose garden. He was referring to the current state of his plan to repeal the Patient Protection and Affordable Care Act (ACA) that was passed by Congress during the Obama administration. For the second time in as many tries, Donald Trump, the man who would be president, is losing in this attempt. What an impression this must have made on these future Air Force officers. The enemy shoots down all your planes, and you declare victory. I was hoping that winning would be made of sterner stuff.

A big sticking point is a critical provision of the ACA. As passed in 2010, insurance companies are unable to deny coverage to patients with pre-existing conditions. It works like this. You don’t have insurance. You know how this works. Insurance premiums cost money, so you don’t purchase a plan. Then you get sick. Really sick. You get cancer. You go to your friendly Aetna agent. “I need health insurance, because I have cancer.” The agent says, “Sorry. We don’t insure a house that’s already on fire.” See, the idea of insurance is everybody pays in, and only the people who need it (have an accident, get sick) reap the benefits. All the others who don’t have accidents or don’t get sick just suck it up. And feel sorry they ever wasted their money.

The problem, before the ACA, was that people who didn’t purchase health insurance and then came to desperately need it were left to fend for themselves, often crowding emergency rooms in hospitals or getting treatment at, for example, county hospitals, where local taxpayers picked up the tab. A key provision of the ACA is that everybody is required to purchase health insurance, and insurance companies are required sign them up, even if they have cancer.

A number of provisions of the ACA rankled conservatives bigly:

  • Forcing people to  purchase something (health insurance) they didn’t want to purchase in the first place is a violation of people’s personal liberty. Conservatives don’t like that.
  • Having taxpayers foot the bill to pay for other people’s insurance premiums is especially obnoxious to conservatives. It’s like… like welfare. Which it is.

Little noticed during the presidential campaign by the throngs of angry Trump supporters was that taxpayers were already footing the bill for people who could not afford to pay. Recall the emergency room visits. You don’t pay here, then the hospital passes the costs along to those who can and do pay, usually through their insurance plans. You get treated at the county hospital. The hospital taxing district pays. A notable example is Parkland Hospital in Dallas. This no slouch of a medical facility. This is where they took the president when he got shot in Dallas. It’s supported by a Dallas County taxing district. I know. I paid the taxes. Poor women, even from neighboring counties, come to Parkland for prenatal care and to have their babies. What the ACA did was to formalize an existing public health service and to  prop it up with an additional tax, which is what the Supreme Court ruled is a tax levied on those who refuse to purchase health insurance.

Anyhow, even Republican lawmakers are balking at elimination of coverage for pre-existing conditions. Trump claims, repeatedly, the current Republican plan does not eliminate this coverage. Reporters questioning Mr. Trump remind him again and again that the current Republican plan allows individual states to opt out of this requirement. What this means is that conservative states, such as my own, will opt out, effectively nullifying the provision to cover pre-existing conditions.

Campaigning, Donald Trump made a number of promises regarding what he would accomplish during his first 100 days. With a Republican in the White House and with Republican majorities in both the Senate and the House of Representatives, Donald Trump managed to push through one Supreme Court nomination. As for the other items, well this is what winning looks like.

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