On President Donald Trump’s first weekend in office, his press secretary lied about the size of the crowds at Trump’s inaugural, then his senior adviser described the lies as “alternative facts.”
Anyone who has watched the Trump campaign or his transition team’s comments about health care should not be surprised. They and allies in Congress have been using “alternative facts” to mislead the American people for months about the Affordable Care Act, its problems and potential solutions.
Republicans in Congress voted against the program en masse and have been trying to repeal it ever since, not because they feared it wouldn’t work, but because they feared it would work all too well.
It is, at heart, a program that redistributes wealth from the affluent to the middle class and the poor, with taxes on the rich paying for subsidies that make coverage more affordable for everyone else. It also ended the worst industry practices, such as caps on annual or lifetime benefits that threatened to bankrupt anyone with a serious illness.
Americans, by wide margins, support these reforms. So the Republicans have had to come up with other arguments to undermine the program.
First they dubbed it “Obamacare,” knowing that their partisans would be less likely to support an initiative linked to a president they oppose. This was a shrewd move; polls have repeatedly shown that the same people who hate “Obamacare” like the “Affordable Care Act” and love most of its individual provisions.
Next, Republicans exaggerated the law’s reach, arguing that it was restructuring the entire health care industry, which allowed them to persuade people that the program was driving up their health costs. In fact, the act’s most important pieces expanded Medicaid for the poor and assistance for people who didn’t have access to coverage through a job.
The cost of employer-sponsored coverage, where most people get their insurance, has hardly been affected. Premium increases for employer-sponsored plans averaged 11 percent a year from 1999 through 2005, but since then the growth rate has been 5 percent annually. If anything, the ACA may be keeping those costs down.
Still, Trump and his Republican allies have been telling Americans that Obamacare is a disaster, that it is crumbling and about to collapse. This isn’t true, either. The program has reduced the number of uninsured by half. This winter, even with all the controversy, more people are enrolling in the program every day.
Obamacare does have problems. It needs more healthy people in the pool to share the risk, and insurance companies need to know that everyone will share in the cost of the most expensive cases. This was part of the bargain for requiring insurance plans to accept all comers, regardless of their health condition.
The Affordable Care Act can be fixed, and Republicans know it. The program is built on a GOP principle – individual responsibility – and uses private markets and competition to keep costs down.
Last week, Republican Sen. Ron Johnson of Wisconsin – no liberal – suggested that Republicans drop their mantra of “repeal and replace” and instead try to work together with Democrats to make the ACA better for everyone.
“Let’s fix it for the benefit of the American public,” he said.
There’s an idea.
Daniel Weintraub is editor of the California Health Report. He can be contacted at Daniel.firstname.lastname@example.org.