Healthcare looks set to dominate the US Presidential elections once again, after a White House call for the repeal of Obamacare sparked a swift response from leading Democrats.
The Trump administration has changed tack on an earlier stance of dropping some parts of the Affordable Care Act – in particular protections for pre-existing medical conditions – in favour of a complete dismantling of the programme.
The move comes after the Department of Justice (DoJ) asked an appeals court to declare the law unconstitutional, in line with a Texas lower court ruling issued in December, but also is against the advice of Health and Human Services Secretary Alex Azar and Attorney General Bill Barr, according to a Politico report.
“The Department of Justice has determined that the district court’s judgment should be affirmed,” said the department in a short filing to the court, where an appeal on the decision is pending. If that happens, it is likely that the case would be referred up to the Supreme Court.
The news prompted an uncharacteristically short tweet from the President, who has made repeated attempts to dismantle the ACA since taking office in 2016, without success.
Obamacare has extended medical insurance to more than 20 million people who previously had no cover by expanding Medicaid which provides healthcare to people on low incomes and also though new federal insurance exchanges. Critics claim premiums are still too high, and the scheme has resulted in fewer plan choices and is too expensive, costing the federal government $62bn last year.
Democrats seized on the change in plan and promptly announced a plan to build up Obamacare, sensing that healthcare is a hot topic that could help them make additional political gains after winning control of the House of Representatives in the mid-terms.
Citing figures from think tank the Urban Institute, the New York Times estimates that repealing the ACA would mean 12 million adults would lose Medicaid coverage, with another three million children who got Medicaid or the Children’s Health Insurance Programme also losing out.
“The Justice Department and the Trump administration decided not only to destroy protections for pre-existing conditions but to tear down every last benefit and protection the ACA has,” said House Speaker Nancy Pelosi at a press conference yesterday.
The new Democrat bill would expand Obamacare’s tax credits – intended to help pay for coverage – to more people, increase the size of those credits, and reduce premiums by proving federal support to insurers for the care of high-cost patients.
To defend the ACA, the bill would also prevent insurance companies from offering non-Obamacare plans that cost less but offer fewer benefits, which were expanded under Trump, and block states from unilaterally watering down elements of the Act including the pre-existing conditions protections.