I have been an emergency doctor in the same small rural community for over 20 years. I’ve witnessed medicine with and without the Affordable Care Act (ACA)—also known as Obamacare—as well as before, during, and after Donald Trump was president. So when Senator JD Vance (R-Ohio), former president Trump’s running mate, said during the vice presidential debate that Trump “saved” the ACA, I thought I had heard wrong. On the ground, in the ER, that was not the reality at all.
The benefit of working in the same small community for a long time is that I get to know patients and their families over the decades. And I often see them in crisis. Far too often, that crisis is the result of a lack of health insurance, which prevents people from seeing a primary care doctor or specialist and leaves them unable to afford prescription drugs that could have prevented them from ending up in the ER.
I remember a man working two jobs who came in at 3 a.m. gasping for breath and clutching an empty rescue inhaler. He did not have insurance and therefore could not see a doctor to manage his COPD or get prescriptions for life-saving medications. This was before 2014, when the ACA was fully implemented. With passage of that landmark legislation, patients like him could finally afford the care they so desperately needed. Whether from expanded Medicaid or premium support for Affordable Care Act plans, 20 million people like him now have insurance when previously they did not.
The ACA was the most meaningful piece of legislation I’ve seen in my career. It improved the lives of my patients. It was the most expansive piece of health care legislation since Medicare and Medicaid were introduced in the 1960s. We still have a lot of work to do to make sure everyone has access to quality, affordable care, but the ACA was a giant leap in the right direction. In fact, ACA Marketplace enrollment was the highest ever this year, at 21 million Americans. In 2010, prior to ACA implementation, the uninsured rate was 16 percent. Today, it’s 7.2 percent.
But this is all despite Donald Trump, not because of him. Trump tried to kill the ACA dozens of times. When he was unsuccessful, he did everything in his power to undermine it and make it less effective, causing higher insurance premiums and higher health care costs for my patients and patients across the United States. Let’s look at the numbers.
For the last four years of Barack Obama’s presidency, the number of uninsured went down year after year. During Trump’s term, the number of uninsured Americans went up by 2.3 million people, leading to thousands of deaths. How Trump achieved this horrific statistic was calculated and multi-faceted.
Trump cut funding for outreach and assistance for people to enroll in ACA coverage. His only legislative achievement was the 2017 tax cut which, in addition to cutting taxes for billionaires and large multinational corporations, eliminated the individual mandate penalty for not having health insurance. This took away the incentive to have insurance so younger, healthier people left the insurance rolls, creating a higher-risk pool of insured and driving up costs.
Trump also stopped subsidies that lowered insurance premiums for millions. Insurance became more expensive, or in some cases impossible to get, and many folks again had to choose between food and health care.
And while making insurance less affordable, Trump allowed “junk” insurance plans to be sold for lower premiums, but these plans covered so little that for many it was like having no insurance at all.
Through his actions, Trump eroded protections for patients—even as he gave huge tax breaks to Big Pharma and large corporations that enriched themselves while raising costs for ordinary Americans. The ACA survived Trump’s attacks. There is no guarantee that it will survive future ones.
As a physician, I strive to keep my patients healthy and advocate for policies that put their wellbeing first. If past is prologue, everything Trump has done and said to undermine health care in the past paints a bleak picture of the effect he will have on health care in a second term. I have to speak up and point out that Trump’s priorities will likely make my patients sicker, poorer, and less able to enjoy a good quality of life.
Dr. Rob Davidson is a West Michigan Emergency Room Physician and the Executive Director of the Committee to Protect Health Care.
The views expressed in this article are the writer’s own.
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