Trump and the GOP's Frightening Plan for Healthcare

While it has received nowhere near enough coverage, the results of the 2024 elections could have a huge negative impact on healthcare coverage for millions of Americans. If Republicans prevail, they want huge cuts in federal spending on healthcare - so that the wealthy can pay less in taxes - and could potentially repeal the Affordable Health Care Act an leave millions without healthcare coverage, throw families at the mercy of insurance companies and large hospital systems, and see prescription drug costs soar.  Added to this is a desire to slash Medicare and Medicaid spending - harming poor working class whites the most - while also attacking Social Security.   Amazingly, many of those who would suffer the most are allowing GOP calls to racism and culture war issues to distract them from the catastrophe of what would happen to their healthcare coverage and even impact the continued financial viability of many rural hospitals. A piece in The Atlantic looks at both what the Biden administration and Democrats want versus they nightmarish Trump/Republican proposals.  The take way is that voters best wake up and realize the threat Republicans pose to their wellbeing.  Here are article highlights:

Expanding access to health care has been a shared policy priority for Joe Biden and the former Democratic presidents who joined him onstage at a lucrative New York City fundraiser last night, Bill Clinton and Barack Obama. But the politics of health care look very different for Biden than they did for his two predecessors.

Clinton and Obama faced widespread public resistance to their health-care plans that forced them to play defense on the issue. Biden and his campaign team, by contrast, see health care as one of his best opportunities to take the offensive against Donald Trump and the GOP.

Health care is one of the few major issues that more voters say they trust Biden than Trump to handle, according to national media polls. And Trump has ensured that voters will see a clear choice on the issue by renewing his pledge to repeal the Affordable Care Act passed under Obama, which now provides health insurance to more than 45 million people.

House Republicans dramatically sharpened that partisan contrast last week when the Republican Study Committee—a conservative group whose membership includes more than four-fifths of the House Republican Conference’s members and all of its leadership—issued a budget proposal that would not only repeal the ACA but also fundamentally restructure Medicare, Medicaid, and the federal tax incentive for employers to provide insurance for their workers.

“At the root of a lot of these Republican Study Committee proposals is reducing what the federal government spends on health care, and putting the risk back on individuals, employers, and states.”

Expanding access to health care has been a priority for Democratic presidents since Harry Truman. . . . Obama succeeded where Truman and Clinton (and, for that matter, Republican Richard Nixon) had failed, by passing the ACA in 2010. But the deeply polarizing legislative fight over the law fueled the Tea Party backlash . . . . The turning point for the ACA came when Trump and congressional Republicans tried to repeal it in 2017. House Republicans passed legislation revoking the law in May that year, and Trump, who had endorsed the effort, immediately marked the occasion by summoning them to the White House Rose Garden for a victory celebration. Trump’s repeal drive failed, though, when three GOP senators voted against it—including the late Senator John McCain, who sealed the effort’s fate with a dramatic thumbs-down gesture on the Senate floor.

During the legislative struggle, public opinion on the ACA flipped. For the first time since Obama had signed the law, more Americans that spring consistently said they supported than opposed the law . . . . KFF’s latest survey last month produced one of the most positive ratings ever for the ACA, with 59 percent supporting it and only 39 percent opposing.

Particularly important was the Democrats’ shift from emphasizing the ACA’s expanded coverage for the uninsured to stressing its provisions barring insurance companies from denying coverage or raising premiums for the millions of Americans with preexisting health problems.

In office, Biden has advanced his agenda as effectively on health care as on any other issue. Between the massive COVID rescue plan, passed in 2021, and the Inflation Reduction Act, approved in 2022, he won big increases in subsidies to help people buy private insurance under the ACA and a suite of policies controlling drug prices for the elderly. Those include obtaining, for the first time, authority for Medicare to negotiate with drug companies for lower prescription-drug prices, a $35 monthly cap on insulin expenses for Medicare recipients, and a $2,000 cap on total annual drug spending for seniors.

This intensified federal effort has driven down the share of Americans without health insurance to less than 8 percent, according to federal surveys. That’s the lowest number ever recorded, and about half the level before the passage of the ACA. A record 21 million people signed up to buy private insurance coverage through the ACA this year, and about 25 million more are covered through its provision expanding access to Medicaid for low-income working adults.

Among other things, the House Republican Study Committee blueprint would: repeal the federal protections the ACA established for people with preexisting conditions and instead allow states to decide whether to retain such reforms, transform Medicare into a “premium support” or voucher system that instead of paying seniors’ health-care bills directly would give them a stipend to purchase private insurance, end the federal entitlement to Medicaid and instead bundle the program into a block grant for states along with a separate federal program that covers children, and rescind the authority Biden won for Medicare to negotiate lower drug prices. (The Project 2025 plan embraces many of these same ideas.)

[L]iberal—and many centrist—health-care analysts see the proposal as a trigger for chaos in the medical system. It’s “a recipe for taking the health-care system, throwing it up in the air, and letting it drop to the ground and seeing who survives,” . . . the GOP plan would likely at least double the share of Americans without health insurance, raising the percentage of uninsured to a level even higher than it stood before the passage of the ACA.

[The biggest losers in these GOP proposals would include the lower-income, older white adults who have become the cornerstone of Republicans’ electoral coalition. Severely retrenching Medicaid would doom many hospitals in red rural communities. The GOP plans to reverse the ACA’s insurance reforms, meanwhile, would likely cut premiums for younger and healthier people at the cost of raising prices and eroding access for those with greater health needs—who tend to be the older lower-income voters Republicans rely on. “It is a war on their base,” Nichols said.

The cumulative impact of the GOP plan is breathtaking: It calls for cutting federal spending on health care by $4.5 trillion over the next decade for people younger than 65. . . . The cuts would mean not only “a lot more people without health insurance” but also massive turmoil for health-care providers, Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, told me. “It would have a huge impact on hospital revenue and provider revenue,” she said.

A Biden victory would allow him to defend, and perhaps further advance, his policies to reduce the number of uninsured and to more aggressively leverage federal buying power to lower health-care costs. If Trump wins, he will roll back federal health-care spending and regulation, and cede more power to providers and insurance companies—by legislation if he can, and by regulatory action if Democrats win enough seats to block him in Congress.

The choice could not be more stark.