Sabotaging the ACA

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Modern American history has never seen as full-scale an effort to sabotage a valid law as we have with President Trump and the Affordable Care Act — a law whose legality has been upheld twice by the US Supreme Court. The president has a legal obligation, under Article II of the US Constitution, to “take Care that the laws be faithfully executed.” That means he must make sure that our laws are implemented in good faith and that he uses his executive discretion reasonably toward that end. His agencies likewise have a legal obligation, under the Administrative Procedure Act — the statute that sets the rules for our entire federal regulatory apparatus — not to use their power to engage in arbitrary action. The intentional, multi-pronged sabotage of the ACA that we have seen during Trump’s presidency — reaching new heights since attempts by Congress to repeal the law failed — violates both Trump’s constitutional obligations and quite possibly the obligations of his Department of Health and Human Services. Trump does not get to say that he can best help the law by killing it and thereby forcing Congress to start afresh. His obligation is to “take care” that the laws that are already on the books are carried out. Since he has flouted this obligation, lawsuits by individuals and states harmed by the damage he causes may now be in order.

Four cities have sued President Trump for “sabotaging” the Affordable Care Act. They have a strong legal case. - Vox

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LOL

ObamaCare is more popular than the GOP tax law, according to a new Fox News poll. The 2010 health-care law registered a 51 percent approval rating, compared with 40 percent for the 2017 Republican tax cuts, according to the survey released on Thursday. The poll, which surveyed 1,009 registered voters, also found that only 36 percent of respondents approve of the way President Trump is handling health care, with 55 percent disapproving.

Fox News poll: ObamaCare more popular than GOP tax law | TheHill

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Be aware, they're going to be at it again now that McCain is gone, who was the swing vote in the previous round..

Senate Republicans say they would like Arizona Gov. Doug Ducey ® to appoint a successor to the late Sen. John McCain (R-Ariz.) who, unlike McCain, would support GOP legislation to repeal ObamaCare. Republican lawmakers say they won’t have time to hold another vote to repeal the law in 2018 but vow to try again next year if they manage to keep their Senate and House majorities. “If we re-engage in that discussion in some point in the future, it would be nice to have members who enable us to pass it,” Senate Republican Conference Chairman John Thune (S.D.) said when asked about the possibility of ObamaCare repeal legislation coming up for a future vote. Sen. Ron Johnson (R-Wis.) said he hopes the next senator from Arizona will be a “strong ally” who “recognizes that ObamaCare is not a proper solution.”

GOP eyes another shot at ObamaCare repeal after McCain’s death | TheHill

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At least some are trying to limit the damage

Senate Democrats are preparing a long-shot procedural maneuver to reverse new Trump administration regulations that they say would sabotage the Affordable Care Act by expanding “junk” insurance that isn’t obligated to cover preexisting conditions. Sen. Tammy Baldwin (D-WI) is leading the effort, introducing a resolution to unwind the Trump administration’s expansion of short-term insurance plans. Those plans are not subject to Obamacare’s rules for preexisting conditions or essential health benefits and Democrats dismiss them as “junk.” “It is sabotage, in my mind, against the guarantees for preexisting conditions,” Baldwin told me and other reporters on Tuesday. “These policies aren’t worth the paper they’re written on.”

Tammy Baldwin: Protect preexisting conditions by banning short-term plans - Vox

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Sabotage seems "successful" 4M people lost their coverage. Here is the former UN Secretary General:

The US has the world’s most expensive health system, accounting for nearly one-fifth of American gross domestic product and costing more than $10,348 per American. The United Kingdom, by comparison, spends a little under 10% of GDP according to the latest available statistics, and healthcare is free at the point of delivery.
“It’s not easy to understand why such a country like the United States, the most resourceful and richest country in the world, does not introduce universal health coverage,” said Ban. “Nobody would understand why almost 30 million people are not covered by insurance.” Failing to provide health coverage, he said, was “unethical” and “politically wrong, morally wrong”. He accused the “powerful” interests of pharmaceutical companies, hospitals and doctors that “inhibit the American government” of having prevented the US from moving towards universal healthcare.

“This is for the people. Leaders are elected because they vowed that they would work for the people,” said Ban. “They are abandoning people because they are poor, then these poor people cannot find a proper medical support.” Despite astronomical spending on health, millions in the US live entirely outside the health system, uninsured and unable to go to the doctor without incurring hundreds or thousands in debt. Since President Trump was elected, an additional 4 million people have lost health coverage, according to a recent survey by the Commonwealth Fund.

Ex-UN chief Ban Ki-moon says US healthcare system is 'morally wrong' | US news | The Guardian

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That 4M people losing coverage after Trump assumed the Presidency, well, perhaps it's payback time..

But one key issue — health care — threatens to erode his support. “We’re going to have insurance for everybody,” Trump told the Washington Post after he was elected. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” So far, that pledge hasn't become a reality.

Earlier this year, my organization, the Texas Medical Center, polled 5,000 people across the country on a range of hot-button health policy issues. We asked the 37 percent of respondents who said they're planning to vote for Trump in 2020, "How likely is it that President Trump’s actions on health-care policies, specifically his support for increasing the number of uninsured, will keep you from voting for him?” Overall, we found a 39 percent reduction in the number of Trump supporters who'd support him for re-election if the number of uninsured increased. That could easily prove to be the difference between winning and losing.

In addition, the survey  asked about provisions of the GOP's American Health Care Act, which would have abolished any previous changes to Medicaid expansion among other changes. In fact, a nonpartisan Congressional Budget Office analysis of the White House-endorsed plan showed it would cause 24 million people to lose insurance — a far cry from "insurance for everybody." The bill fell a single vote shy of passing.

About 90 percent of respondents in our survey said that Medicaid should be extended to all poor adults, and 82 percent don’t want to limit the amount Medicaid pays for a sick patient. It is possible that if that bill had passed, Trump would have lost a large number of supporters.

Poll shows Trump could be in jeopardy if uninsured rate increases | TheHill

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The Trump administration is planning hours-long downtimes for maintenance on healthcare.gov during the coming ObamaCare sign-up period. The administration drew criticism for a similar move last year from advocates who said the downtime would hinder efforts to sign people up for coverage, but the administration counters that maintenance downtime happens every year and is designed to occur during the slowest periods on the site. The maintenance schedule is the same as last year, the federal Centers for Medicare and Medicaid Services said Tuesday, meaning healthcare.gov is scheduled to be offline for maintenance from 12 a.m. to 12 p.m. each Sunday during the sign-up period, except for the final Sunday, for a total of 60 hours of downtime.

Trump officials plan maintenance downtime for healthcare.gov during ObamaCare sign-ups | TheHill

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The number of uninsured children in America is on the rise. An estimated 3.9 million children were uninsured in 2017, according to new research from Georgetown University’s Center for Children and Families, up from 3.6 million in 2016. Every state saw an increase in their share of uninsured children; Washington, D.C. did not. Two charts tell the story: For the last decade, more and more American children were getting insurance coverage. Then in 2017, that trend suddenly reversed... 

The most likely culprits, per the report: 

• The Republican pursuit of Obamacare repeal and their success in repealing the individual mandate.
  
• The Trump administration’s regulations that undermine the health care law.
  
• Congress allowed an unprecedented lapse in funding authorization for the Children’s Health Insurance Program.
  
• President Trump’s immigration crackdown: Nearly 1 in 4 children in the US have a parent who is an immigrant, and we have strong evidence that an unwelcoming environment for that population leads them to pull out of public programs similar to CHIP and Medicaid..
  

Declines in child coverage rates occurred in 2017 despite an improving economy and low unemployment rate, strongly suggesting that federal actions contributed to a perception that publicly funded health coverage options are no longer available or, in the case of an immigrant parent, created concern about enrolling their child in public coverage for fear of reprisal. 

Uninsured rate for children is growing under Donald Trump - Vox
Sabotage is working and making real victims. Defenseless children..

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And keep in mind that the case was brought on by right-wingers arguing they were in favor of protection for pre-existing conditions..

The Texas ruling finding the Affordable Care Act unconstitutional is ludicrous in its reasoning and unlikely to survive appeal. It argues, in short, that since Congress removed the penalty from the individual mandate, the individual mandate is no longer a tax; because the individual mandate is not a tax, it is no longer constitutional; and if the mandate is no longer constitutional, the entire law must be judged unconstitutional.

To do anything else would be, of course, immodest. As Judge Reed O’Connor writes, courts “are not tasked with, nor are they suited to, policymaking.” Yes, he is literally writing that as he tries to overturn Obamacare with a stroke of his pen. You can almost hear the “lol” he must’ve deleted from the first draft.

“If you were ever tempted to think that right-wing judges weren’t activist — that they were only ‘enforcing the Constitution’ or ‘reading the statute’ — this will persuade you to knock it off,” wrote law professor Nicholas Bagley. “This is insanity in print, and it will not stand up on appeal.”

You might spy a hole in O’Connor’s reasoning: Wasn’t it Congress that chose to remove the penalty from the individual mandate without choosing to repeal all of Obamacare? And as such, isn’t it quite clear that Congress intended Obamacare to stand even without an individual mandate imposing a penalty?

Ah, but O’Connor has thought of this. He says that since the Congress that repealed the individual mandate was working through budget reconciliation and couldn’t repeal the mandate, “the 2017 Congress had no intent with respect to the Individual Mandate’s severability” (“severability” refers to whether a provision can be severed from a law while the law still stands). And he goes on to say that even if he’s wrong, and the 2017 Congress did intend to do what it did, what it intended to do was to leave the mandate intact but penalty-less, thus leaving it unconstitutional, thus leaving the whole law unconstitutional.

If this doesn’t make sense to you, that’s because it doesn’t make sense. Even the Trump administration didn’t want the judge to go this far. They asked that he simply kill the individual mandate and the protections for preexisting conditions, but leave the rest of the law standing.

The Texas ruling overturning Obamacare is a boon to Medicare-for-all - Vox

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About 7 million fewer Americans had health insurance at the end of last year compared with two years prior, and the share of people who are uninsured is the highest it’s been since 2014, according to a new survey. During the fourth quarter of 2018, 14 percent of Americans were uninsured. That’s up from 11 percent at the end of 2016, and the increase has been steady over the months since then, according to the latest figures from the Gallup National Health and Well-Being Index, released Wednesday. Women, people who earn less than $48,000 a year and adults younger than 35 saw the highest increases in the uninsured rate.

7 million Americans have lost their healthcare insurance under Donald Trump — so far – Alternet.org