At the dawn of the Trump era in American politics, it’s important for caring and thinking people to guard against the use of hyperbole and alarmist rhetoric and to avoid making too many “the sky is falling pronouncements.” As was noted in this space last November, there are plenty of reasons to think that some of the worst components of Trumpism can be blunted or even defeated with a little luck and a lot of hard work. And, as North Carolinians have learned during six years of aggressive right-wing rule, the conservative movement is often a fractious, divided and mistake-prone crusade that is fully capable of committing absurd and self-destructive blunders. It can and will be defeated in the months and years ahead.
All that said, there is really no way to overstate the utter devastation – both to human wellbeing and economic stability – that is on the horizon if the President-elect and congressional Republicans make good on their promise to repeal the Affordable Care Act without first developing and implementing some kind of realistic alternative. Simply put, thousands of people will die unnecessary and premature deaths and a large swath of the economy will suffer mightily.
Calculating the death toll
How do we know this? It’s not really that complicated. According to independent experts, Obamacare has, for all of its many imperfections, saved (and is saving) tens of thousands of Americans from deaths they would have otherwise suffered. It’s done this by securing health insurance (and thus, access to decent, affordable health care for millions of people not previously covered) and by ushering in a host of other beneficial healthcare system changes.
“The president’s statement could have been a bit more precisely worded to reflect some of the uncertainty in the estimate: ‘likely a major reason why we’ve seen an estimated 50,000 fewer preventable patient deaths in hospitals.’
But that’s a relatively minor quibble. The numbers might seem large, but the research seems solid, according to experts we consulted, and it is based on a review of an extensive database. The results likely reflect work that predated the ACA but at the same time the ACA has spurred even greater cooperation among hospitals. Since the president is using a figure more than a year old, it is likely understated….”
And of course, before the ACA even went into effect, we knew that thousands upon thousands of Americans were dying each year for lack of insurance and access to care – as many as 1,000 or more each year in North Carolina alone.
All of this stands to reason. As anyone who has ever had a friend or loved one who lacked insurance or the ability to pay for necessary care or medicine can attest, the simple truth is that such people are far more likely go without care. And make no mistake, far more people have care today than they did eight years ago. As the Kaiser Family Foundation reported last month, this difference is especially pronounced in the realm of Medicaid:
“By 2015, an estimated 11 million Medicaid enrollees nationally were adults who were made newly eligible by the expansion. They were part of a larger net increase in Medicaid enrollment since the implementation of the ACA….
The Medicaid enrollment gains contributed to a big decline in the uninsured rate among nonelderly individuals in the U.S., which fell from 16.6 percent in 2013 to a historic low of 10 percent in 2016.”
Obamacare’s breakthrough elimination of the dreaded “pre-existing condition” bar to health coverage is another enormous factor in the nation’s progress. Consider the following key findings from an in-depth study conducted by the Office of the Assistant Secretary for Planning and Evaluation for the U.S. Department of Health and Human Services:
“Between 2010 and 2014, when the ACA’s major health insurance reforms first took effect, the share of Americans with pre-existing conditions who went uninsured all year fell by 22 percent, meaning 3.6 million fewer people went uninsured.
[In contrast, a]bout 23 percent (31 million) experienced at least one month without insurance coverage in 2014, and nearly one-third (44 million) went uninsured for at least one month during the two-year period beginning in 2013.
Think about what that means – not just in terms of lives directly saved, but also in terms of the fear and anxiety removed for millions of people. The same study found that 51% of the nonelderly population (133 million people) may have a pre-existing condition. Surely, millions of these Americans are much better off – if only for lack of the fear and anxiety that they were forced to carry prior to the guarantees included in the law.
The economic toll
Even for those hard-hearted individuals who won’t allow themselves to worry about the human toll of repeal, one would think the economic impacts might make a difference. Consider these findings from a new and in-depth report released last week by researchers at George Washington University entitled “The Economic and Employment Consequences of Repealing Federal Health Reform: A 50 State Analysis”:
“About 2.6 million jobs could be lost nationwide in 2019, rising to almost 3 million by 2021. Every state would experience major job losses.
Almost all of the jobs lost are in the private sector. Almost a million (912,000) are in health care, while the remaining two-thirds are in other industries, including construction, real estate, retail trade, finance and insurance.
States with the highest job losses in 2019 include: California (334,000 jobs), Florida (181,000), Texas (175,000), Pennsylvania (137,000), New York (131,000), Ohio (126,000), Illinois (114,000), Michigan (102,000), New Jersey (86,000) and North Carolina (76,000) (emphasis supplied).
Gross state products (state-level analogues to the gross domestic product for the nation) could decline by $256 billion in 2019. Total business output would fall by almost half a trillion dollars ($441 billion) in 2019. Over five years, from 2019 to 2023, gross state products could fall by $1.5 trillion and total business output could be cut by $2.6 trillion.
These losses could also trigger reductions in state and local tax revenues, amounting to about $48 billion lost over five years….Repealing premium tax credits, by itself, would be responsible for the loss of about 1.1 million jobs in 2019. The repeal of Medicaid expansion alone would reduce employment by 1.5 million.
All the states will experience negative economic effects if Medicaid expansions are revoked, even the 19 states that have not expanded. Workers and businesses located in Medicaid expansion states purchase goods and services from non-expanding states, so the negative effects of cancelling Medicaid expansions ripple out to all states.
A local ACA expert adds this about the situation in North Carolina:
“Yes, even without Medicaid expansion, the impact of loss of ACA would be high in NC since we have the fourth highest enrollment and our enrollees get a higher than the average tax subsidy. In other words, North Carolinians want health coverage, and hence enroll at a higher rate than most other states, and there are many North Carolinians with lower income who enroll.”
The conservative/Trumpist retort to these data, of course, is that the GOP will not just repeal the Affordable Care Act, but replace it with “something better.” The problem with this promise, however, is that such a path has proved utterly illusive, because, as the old saying goes, “there’s no free lunch.” New York Times columnist Nicholas Kristof put it aptly this way last week:
“Trump would have you believe that he will keep the popular parts of Obamacare, such as the ban on discriminating against pre-existing conditions, while eliminating unpopular parts like the mandate. That’s impossible: The good and bad depend on each other.
The Trump approach would be like trying to amputate a dog’s rear end so you wouldn’t have to clean up its messes. It just doesn’t work that way.”
In recent days, the hard realities represented by these dire facts and numbers have caused some conservative leaders to start to express some hesitancy about plowing ahead without a realistic alternative to Obamacare. Let’s hope fervently that similar light bulbs continue to click on all over the nation in the days ahead.
Above image: Adobe Stock.