The Affordable Care Act

From the get go I was always frustrated when people termed the Affordable Care Act "Obamacare." President Obama did the best he could with it, ultimately trying to defang the term by saying he liked it and would take the credit. But ultimately the terminology was designed by the far right wing media with one goal in mind: to play to their base. That base is many things, but regardless of how many are racist, or dislike the idea of "welfare," or just don't like "liberals," the one thing that base agreed on was that Obama was terrible. Tying his name to the act was extremely effective. For further proof, look at these interviews, conduct by Jimmy Kimmel Live:

I know that it's a bit for humor, but man oh man does that have to make you shake your head. What isn't humorous is how the Trump Administration is barreling head first towards gutting the law, without a replacement in place, while the majority of American's firmly want the law to stay the same or, at least, not be messed with until something better is lined up.

Today, in brief, I want to present you with what I believe are two plausible scenarios, in light of Trump's Executive Order entitled "Minimizing The Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal." What this order does, in sum, is direct the Department of Health and Human Services to ... well, we don't really know. That's how vague it is. But it puts the department, and other departments on notice, and the changes could be relatively big.

I suspect that one change will be the Trump Administration doing away with the ACA's requirement that birth control and contraceptives be covered. Now, as we all know, "Social Conservatives" have, for years, complained about Roe v Wade and the "scourge" of abortion on our society. What I'm about to say may seem like an out there projection, but I suspect that not only will the Trump Administration do away with the birth control and contraceptives interpretation, but that it will do so not just to attack women's rights (under the guise of freedom of religion), but also in a backhanded attempt to stir up support for trying to take on Roe v Wade again. In all the news recently, this report might have been lost in the shuffle. In short, abortion rates in this country are at their lowest rate since Roe v Wade was decided. I strongly suspect that the ACA's mandate that birth control and contraceptives be covered is a major contributing factor for this. I also strongly suspect that if that requirement, along with wellness visits and other covered aspects, are done away with then the numbers will rise again.  And, as those numbers rise, the social conservatives in the US government (disproportionately white men, for what it's worth) will rise up and talk about the need to overturn Roe v Wade again.

A second change I suspect will be coming soon to the ACA relates to the individual mandate. Without getting too bogged down in the weeds, the ACA says that all persons, regardless of pre-existing conditions, can get coverage. The people who want insurance the most, of course, are those with pre-existing conditions. But if only those people sign up the cost of insurance would be astronomical, both to the insurance company and then, ultimately, to the purchaser of insurance. There has been a ton of noise in the Alt Right media about the premium increases under President Obama, but the fact is that the cost of insurance, while still on the rise, has slowed under the ACA, although their rise at the end of 2016, heading into this year paints a less optimistic picture.

Much of the cost control mechanism for the act, however, is due to the individual mandate. Without it, younger, healthier people would likely opt out of insurance, increasing the cost to insurance companies per person insured, and increasing the cost sent back to the purchaser of insurance. If the Trump Administration effectively eliminates the individual mandate, then, without "repealing" the law, the cost of insurance will skyrocket. That, in turn, would allow them the ability to claim that the law is completely broken, and repeal it even if they don't have a worthy replacement.

Simply put, this administration is playing politics with American's income, health care, and well being, less than two full days into their term in office. Repealing the ACA, even parts of it, would likely lead to 18 million Americans losing their insurance. You can bet that whatever takes its place will benefit Trump's friends and backers the most. Now, that is not very far from any level of politics. And the ACA is far from perfect. But to repeal it without a viable, ready to go on the day of repeal, replacement plan would likely be devastating for millions of Americans. To play politics with it to strive towards a social end, like a pincer attack on abortion rights, is downright unethical and immoral.