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For healthcare, just about everything is at stake, and, as usual, it’s complicated. 

Trump is now hell-bent on killing the entire Affordable Care Act, and although many Republicans would like to do the same, they are fearful that this might hurt their re-election chances due to the large number of people (a minimum of 20 million) who would lose their healthcare. (Already, millions who before the pandemic had had healthcare insurance through their employer have lost that, making the prospect of the total number of uninsured astronomical.) Due to this election concern, hearings on the Supreme Court case on the ACA, a moving target, was changed again to just afterthe election (November 10), protecting Republican incumbents who really would like to see the ACA destroyed.

The ACA had ended some of the most egregious practices of many private insurance companies. At the top of the list is the ability to deny coverage or make its costs skyrocket for people with preexisting conditions.  One in two Americans has a preexisting condition, ranging from migraine headaches to cancer (Center for Medicare & Medicaid Services). While Trump has off and on promised to restore that protection, without other protections (for insurance companies) that the ACA has in place, insurance companies would revolt. 

There’s more, which many people now take for granted. The ACA includes coverage for 10 essential benefits that must be offered by all individual and small group health insurance plans—from maternity to substance abuse treatment and prescription drug coverage. No ACA, mandate GONE. 

The ACA limits annual consumer spending on in-network essential health benefits covered under most health plans. For 2020, these out-of-pocket maximum limits (which exclude premium costs) are $8,150 for an individual and $16,300 for a family ( GONE are these caps on consumer costs.

If the ACA goes, people on Medicare would face a re-opened “doughnut hole,” having to pay full price for pharmaceuticals when their payments have reached a certain level.

This is just a snapshot of protections created by the ACA that would end.

Along with these protections, the Medicaid expansions across the country created through the ACA would be defunded by the federal government. To date, 39 states have adopted a Medicaid expansion (Kaiser Family Foundation). As of mid-1919, 765,600 Pennsylvanians got coverage through our Medicaid expansion. State expansions have largely been very successful in getting comprehensive healthcare coverage for people who had no other options.

What else is at stake in this election as part of healthcare?  Medicare and Medicaid could face drastic cuts that Trump continues to pursue (originally, to make up for lost tax revenues due to the massive giveaway to the top 10% earners in the country, and now, to reduce the ballooning deficit due to incompetent leadership during the pandemic). 

Republicans have never had a plan for healthcare, other than to return to the pre-Obama days of a free-market, largely unregulated, healthcare system when insurance companies could drive very sick or injured people to bankruptcy. Trump has made over 15 promises that he has a “great” healthcare plan to replace the ACA. It has never seen the light of day. (Oh, yes, Trump did have one plan that was implemented for a short time:  a cheap healthcare insurance that paid for hardly anything and became known as the “skimpy” plan. It was denounced by the Pa insurance commissioner as being worthless.) Going back in history to long before Trump, Republicans have well-earned the label of “the party of No Care.”

In contrast, Democrats running for office in this election—from Biden/Harris to “Down Ballot” candidates in our district, Todd Rowley for Congress and Rich Sterner for Pa Senate—all believe in healthcare as a human right and making healthcare coverage comprehensive, affordable and accessible to everyone. From Biden on down, they have been hard at work in outlining their plans. None of the Democratic candidates in our neck of the woods, including Biden/Harris, intends to fly in the face of people who are afraid of losing their existing health insurance – so forget the Republican  label of “socialism,” which has been misused so frequently as to be ridiculous.

Democratic candidates are working on a solution that would shore up the ACA (reinstating critical cuts made by Republicans) and improve it. They are considering adding a public option, which may involve Medicare or Medicaid. In addition, Governor Wolf has a team that has nearly ready a state-run exchange on the ACA that promises to bring costs down, expand enrollment periods, and make other improvements. The exchange will be up and running for enrollment in December—UNLESS . . .

If the lawsuit to abolish the ACA (on tortuous grounds) is successful whenever it is finally decided, nearly all plans Democrats have for improving the ACA are for naught.

This brings us to the complication of the Supreme Court decision.  So close to the election, the country lost a champion of women’s rights, Ruth Bader Ginsburg. For a long time we have known that to replace her, Trump would nominate a person who would please his fundamentalist Pro-Life Base. Thus, reproductive rights, supported by the vast majority of people in our nation, are in serious danger. These rights include not only the right to an abortion, but also the availability of free or low-cost contraception (a key to reducing abortions), and healthcare for hundreds of low-income women who depend on Planned Parenthood clinics for much of their healthcare, particularly women living in rural areas. Reproductive rights are a health and economic issue, affecting millions of women, but especially those who are financially insecure.

Drawing from the arch conservative Federalist Society’s list, Trump chose Amy Coney Barrett to replace RBG, and her nomination and approval were rushed through in the midst of a heated election. Having received affirmative votes from only Republican Senators, she will be on the bench before the November 10 Supreme Court hearing on the ACA’s legitimacy. Barrett has questioned the ACA’s  “Constitutionality,” and she will likely vote to abolish it. As SCOTUS justices are appointed for life, Barrett’s appointment will affect generations to come.

What can we do?  Our only hope is for you, me, and the nation (especially swing states like ours) to vote for Democrats up and down the ballot. Although the replacement for RBG is now out of their hands, Democrats must do everything they can to prevent yet another arch conservative from further packing the highest court in the land and destroying its integrity and desperately needed balance.

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Jeanne Duffy, Ph.D., has served as a college professor, an analyst and project manager for several large companies, and a college administrator in charge of foundation and government support. She is on the Steering Committee of Gettysburg Democracy for America and a member of its Government Accountability and Healthcare task forces.

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