One of President-Elect Donald Trump’s key campaign promises has been the repeal of the Affordable Care Act. In this post, I’m going to explore why that’s a bad idea.

What does the ACA do?

The ACA is a very comprehensive form of healthcare reform introduced by President Obama in 2010. The main crux of the proposal was developed by the Heritage Foundation, a conservative think-tank, in the 1989. In the 1990s, something similar to the ACA became the principal healthcare plan of the GOP. Of course, since President Obama’s election, the level of extremism and partisanship within the GOP has persuaded most Republicans to strongly oppose President Obama’s plan — all of them forgetting, inevitably, that it was their plan during the presidency of Bill Clinton. The reason for that is one I’m willing to go over in another post, but, in short, it involves the problems with the American political establishment in general.

The ACA does a lot of things, and I’m going to talk about a few things it does. First, it substantially simplified means by which health insurance could be achieved for multiple people, prohibiting insurers from denying insurance to people with underlying disorders, expanding Medicaid eligibility to 38% higher than the poverty level, expanding the amount of time for which dependents were allowed to be in their parents’ insurance plan, and providing advanceable, refundable tax credits to those unable to afford health insurance. Second, it mandated that all individuals that could sufficiently afford health insurance who weren’t already covered by a public health insurance plan to buy health insurance, and mandated that businesses that employed 50 or more people offer health insurance to all their employees. Third, it substantially changed insurance standards by mandating coverage of essential diseases, contraception, etc. and created public Accountable Care Organizations to give quality care to Medicaid/Medicare patients.

Why should the ACA not be abolished?

The Republicans have been trying to abolish the ACA for a long time, since they seem to represent corporate interests more than the Democrats do. This isn’t me supporting the Democrats — my cynicism of the US political systems, or of these so-called “democracies” that serve interests of Big Money rather than the people in general, applies to all partisanship — but acknowledging the reality that the GOP is even worse, because they’ve drifted off the political spectrum into the realm of the far-right. Not nearly as far-right as fascists, but pretty right-wing.

The level of partisanship the GOP engages in is staggering — the only reason they want to engage in such mass privatization of healthcare is that their voter base doesn’t want their hard-earned money wasted on the “irrelevant” poor. President-Elect Trump is definitely substantially more reasonable in terms of economics than most of the GOP establishment, when you consider the existence of movements such as the “tea party,” and the “Freedom Caucus,” that simply don’t have a replacement plan. They simply don’t care, insofar as they get votes and campaign money.

The point is, the ACA has helped the people. Not as well as I would have liked it to have, but it has. It has given 23 million people health insurance, and has saved over 50,000 lives. The basic utilitarian argument applies. The idea that it has caused the increase of healthcare prices is similarly ridiculous — in fact, it has been credited with slowing down the inflation of insurance prices. In addition, the Congressional Budget Office estimates that 18 million people would lose their insurance in the first year of ACA repeal.

If you’re abolishing the ACA, you’re going to have to have a more effective plan. Some people do. The GOP doesn’t have one, nor does the Libertarian Party (whose plan is the lack of one). Unless the US government wants to kill its own people, it would be ridiculous to abolish the ACA.

How should the healthcare system be reformed?

There’s no doubt that there are problems with the ACA. My problem with the plan to repeal it is that there’s no alternative that has been suggested, outside of extremely free market plans that are typical of the Freedom Caucus and similar far-right portions of the GOP (as well as the substantially less important Libertarian Party). Two main problems: (1) things like the medical device tax often disproportionately affect middle-income people, and (2) large pharmaceutical and insurance companies continue raising costs, harming both the people and the government.

The first problem requires some alternative means of taxation to fund the ACA, which could mean moderate hikes in the capital gains and income tax brackets, specifically at the top rates, and the closing of corporate tax loopholes. The second problem — which directly ties into the first problem — has a few solutions, which I’m going to talk about. But to explain the second problem, healthcare in the US is substantially more expensive than any other country in the industrialized world — twice as much as, for instance, Denmark.

First, a public health insurance option should be introduced with substantially lower prices than ordinary insurance companies. This would prompt more people to go with public health insurance and possibly create the competition required to reduce healthcare costs. Second, substantial cost-controlling reforms need to be introduced. Here, I would support multiple of Secretary Hillary Clinton’s proposals, such as her plan for lowering prescription drug costs. I would also propose similar measures to reduce insurance costs. Third, I would consider tougher antitrust legislation, the details of which I’m not sure of, but which would regulate insurance companies and expand the Affordable Care Act’s current regulation.

President Obama signing the ACA into law. Source: Wikipedia. Public Domain.

All of this could eventually even make Bernie Sanders’ single-payer plan possible — essentially expanding the public insurance system, or increasing Medicaid/Medicare eligibility, to one hundred percent coverage, which would be ideal but is currently not financially tenable as a result of the power Big Pharma holds over the American people.

It’s time to fight the ideological dogmatism and corporatism entrenched within the American political system, by working towards giving people a right to healthcare.