Trump war on Obamacare front and center during COVID-19 pandemic

U.S. President Donald Trump speaks during a rally at UW Milwaukee's Panther Arena. (Photo by Joshua Lott/Getty Images)

The coronavirus is a double whammy. Many are losing health coverage at the same time they’re threatened with a disease that often leads to hospital stays that can be ruinously expensive.

So, amid spiraling job losses, millions are expected to buy individual health plans on exchanges under the Affordable Care Act, also known as Obamacare. But will the coverage survive challenges posed by the Trump administration and state attorneys general?

As of May 2, an estimated 27 million Americans were newly uninsured due to a job loss, the Kaiser Family Foundation reported. 

Of them, nearly 13 million were estimated to be eligible for Medicaid because they make 138% or less of federal poverty guidelines in states such as Ohio, which expanded eligibility under the ACA. Another 8 million are eligible for subsidies on the ACA exchanges because they’re making 400% or less of poverty guidelines, Kaiser reported.

The ACA, former President Barack Obama’s signature health law, has been under attack by his successor, President Donald Trump. On the day Trump was sworn into office, he ordered his administration to stop implementing parts of the law while Republicans in Congress prepared an attempt to repeal it.

The attempt at repeal famously failed, and Trump continues to attack now-deceased U.S. Sen. John McCain, R-Ariz., over his “no” vote. Subsequently, Trump’s administration has taken myriad other steps to undermine the health law, including:

  • Ending the “individual mandate” — the requirement that the uninsured get coverage or face a tax penalty. The idea behind the mandate was to bring younger, healthier people into the risk pool to protect insurers.
  • Allowing states to impose “work requirements” for those on Medicaid. In Arkansas, the one state where the requirement was fully in effect, tens of thousands were kicked off the program — not because they weren’t complying with the requirement, but because they had difficulty meeting the reporting requirements, NPR reported last October. Some experts call such measures increasing the “hassle factor.”
  • Slashing funds to market the ACA and facilitate signups for the program
  • Ending subsidies to keep insurers on the exchanges

In addition to these measures, Trump is backing a lawsuit by some Republican state attorneys general to wipe out the ACA altogether.

Some of these measures might have had an effect.

Rates of uninsured Americans dropped through the years after 2014 implementation of the ACA. But then they climbed from the start of the Trump presidency through 2018, Gallup reported.

With the coronavirus pandemic suddenly creating masses of newly uninsured Ohioans, it’s vital that government officials take steps to shore up ACA exchanges — where individuals can buy insurance and many can receive subsidies to do so, said Greg Moody, director of former Republican Gov. John Kasich’s Office of Health Transformation as Ohio expanded its Medicaid program under the ACA. 

Moody said healthy exchanges reduce the number of people on Medicaid, which costs state and federal governments vastly more money.

“In Ohio, the big shift from uninsured to insured was through Medicaid,” said Moody, who now is an executive-in-residence at Ohio State’s John Glenn College of Public Affairs. “The individual market was critically important, but the numbers were just much smaller. The issue is that when the individual market is not healthy and people drop (their insurance) they’re more likely to go into the Medicaid program. Those two things are related to each other.”

However, it’s unclear whether state leaders will see it that way. 

U.S. Sen. Sherrod Brown, D-Ohio, again called to reverse the cuts Trump has made to the health law.

“The fact that President Trump and Republican governors continue spending taxpayer dollars to sabotage the healthcare of millions of Americans is despicable, and the fact that they’re doing it during a pandemic is inexcusable,” he said in an email. “We should be working to make it easier, not harder, for Ohioans to access healthcare. Millions of Americans are uninsured and anxious — they’re worried about their health, and they’re worried about what to do if they have to go to the hospital, and don’t have insurance. President Trump needs to stop the partisan fights, and open up the ACA marketplace so that Ohioans who need it can sign up for health coverage.”

For his part, Gov. Mike DeWine didn’t respond to questions about Trump’s actions regarding the ACA — including whether DeWine supported overturning it in court. Earlier this month, the Republican governor also wouldn’t answer directly when asked whether he supported a call by the National Governors’ Association to increase the share of Medicaid paid by the federal government.

A spokeswoman for U.S. Sen. Rob Portman, R-Ohio, wouldn’t address the ACA lawsuit, but slammed the law itself.

“Rob has always believed that the ACA has constitutional challenges, however he isn’t going to comment on pending court cases,” the spokeswoman, Emmalee Kalmbach, said in an email. 

She added that Portman wants Congress to take steps to lower the cost of care, which she blamed Obamacare for increasing. 

“The ACA has increased already high insurance premiums and made health care more expensive,” Kalmbach said. “The Senate was working on bipartisan proposals to address some of these issues last year, including to eliminate surprise medical billing and lower prescription drug costs. Rob hopes the Senate can take up these efforts again as they continue to work through this pandemic.”  

Meanwhile, private insurers appear to be headed back to the exchanges amid the pandemic — despite the fact that Trump cut subsidies designed to get them there in the first place.

“In the coming months, millions of individuals are expected to turn to the ACA exchanges in order to secure coverage,” Politico quoted the lobby group America’s Health Insurance Plans as saying in a brief to the U.S. Supreme Court on Wednesday. 

The insurance group was urging the high court not to overturn Obamacare.

Moody said that policymakers should set ideology aside during the pandemic.

“The question is, in the middle of a crisis, do you take actions that have been recently proven to work as a strategy to get through the crisis?” he asked.