Greg Ranzini '18
Regular Law Weekly readers may recall my comment back in March that the Affordable Care Act had received a “stay of execution” with the failure of the Trumpcare vote:
It remains to be seen whether Trump will follow through on last week’s threat to abandon the idea should this attempt fail. Even if he were to try again, however, his party is unlikely to play ball for the moment: his “threatened” outcome affords them a vital opportunity to save face. Still, expect them to return to the issue just as soon as their President’s goldfish-like attention span scuttles their tax reform plans.
Gregory Ranzini, Trump and Gorsuch Would Like You to Know that You Do Not Exist, Va. L. Wkly., Mar. 29, 2017, at 2.
Three weeks ago, in the wake of the collapse of the Graham-Cassidy bill and the GOP’s return to agitating for tax cuts, I semi-seriously considered seeing whether the Law Weekly editorial board would let me get away with running a lightly-edited version of that same column, in the manner of The Onion’s recurring mass-shooting response, ‘No Way to Prevent This,’ Says Only Nation Where This Regularly Happens. Ah—the heady days of, uh, last week!
This loathsome-but-familiar state of affairs proceeded as scripted until, in the pre-dawn darkness of 2:36 a.m. this past Friday the 13th, a particularly large plaque of β-amyloid in the President’s brain spoke up to remind him that he hates scripts:
Yep, it’s that other tragic motif in American society: an embittered and disillusioned white man stews in extremist media until he lashes out, hell-bent on killing as many of his perceived enemies as possible before They can take him down.
If you enjoy “pure applesauce” with your free Chick-fil-A, you’re likely to take exception to this metaphorical jiggery-pokery—surely we can’t compare gun violence, which everybody knows is the result of an incomprehensible evil which is completely out of the power of government to mitigate or control, to the spiteful executive orders of a man who has to be periodically talked down from pushing the nuclear button, whose own Secretary of State calls him a “fucking moron”? After all, it’s not like any mechanism exists by which Congress could—
So let’s look at the numbers. The Affordable Care Act reduced the uninsured rate among nonelderly Americans from a high of 18.2% in 2010 to a low of 10.4% last year. Kaiser Family Foundation, Key Facts about the Uninsured Population (2017), available at https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/. In 2009, a study published in the American Journal of Public Health found that almost 45,000 deaths per year could be directly attributed to lack of health insurance in the United States. See Wilper, et. al., Health Insurance and Mortality in US Adults, 99 Am. J. Pub. Health 2289, 2294 (Dec. 2009). A 2002 consensus study report by the Institute of Medicine placed the number at about 18,000. Committee on the Consequences of Uninsurance, Institute of Medicine, Care Without Coverage: Too Little, Too Late 162 (2002). A researcher for the Urban Institute, applying the IOM’s methodology to newer data, estimated the 2006 as 22,000. Stan Dorn, Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality 3. Yes, there is a great deal of variation in these estimates, in large part because it is difficult to pick apart the correlated effects of economic inequality, geography, and racism on trends in insurance availability. But the bottom line is, reversing the ACA will leave a lot more people without insurance and, if you don’t have insurance, it is around 20% to 40% more likely than otherwise that you will die within a year. Beyond a doubt, a great many people will die. Denying that taking away people’s health insurance substantially increases mortality is like denying that climate change exists: the unfeeling, actuarial math doesn’t care who you voted for in 2016.
Donald Trump, by contrast, does care. Indeed, he’s still stinging from his win and looking for ways of punishing his political, racial, and class enemies. So it is that, somewhere between establishing a taskforce to address a completely imaginary wave of voter fraud through voter suppression, issuing a succession of racist orders on immigration, and encouraging his attorney general to roll back what modest gains the Obama Administration made against police brutality, he has found the time to work on dismantling the Affordable Care Act. On his watch, the Department of Health and Human Services has cut open enrollment for exchange plans in half, from ninety to forty-five days, and scheduled twelve-hour healthcare.gov downtimes on each Sunday during that period. They have also slashed the advertising budget for the program, diverted HHS funds to film anti-ACA testimonials, and removed entire categories of public-facing information on the program from their website. Trump’s decision to skive off cost-sharing reduction payments is part of a larger plan to break as much of the ACA as possible and let somebody else clean it up. Or, in Trump’s words: “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!”
It is unclear how Congressional Democrats plan on addressing this threat. For the moment, they still seem to be mostly intent on fending off each individual repeal bill as it is introduced, and leaving the President’s executive overreaches to the judiciary. They would be well-served to consider the events of this past week a lesson. When you’re still playing defense against adversaries like Trump and the GOP, celebration is always premature.