The Affordable Care Act, which not that long ago appeared doomed by Republican determination to kill it, has quietly become an integral and accepted part of America’s health care system. A record 14.5 million Americans this year have signed up to get their health insurance through the act’s insurance marketplaces, thanks in large part to the Biden administration’s efforts to reverse the sabotage of the Trump years and make the program work.
The ACA, better known as Obamacare, is still far from perfect. But with the partisan wrangling and court battles finally subsiding, the long-term judgment of history for this once-controversial program is coming into focus. As Americans this year decide whether to hand Congress back to the party that spent a decade frantically trying to prevent Obamacare’s benefits from being realized, it’s worth stepping back and reviewing this epic achievement.
When then-President Barack Obama and a Democratic Congress approved the act in 2010, over fervent Republican resistance, America’s health care system was a national tragedy and a global embarrassment. Tens of millions of Americans couldn’t obtain health insurance because their jobs didn’t provide policies, or they had preexisting medical conditions for which insurance companies could refuse them coverage. For huge swaths of society, preventive care was out of reach, and lifelong medical debt was just one heart attack or car accident away.
Even under those dire conditions, America was not (and likely is not yet) ready to rethink the notion that health care should be treated as a for-profit industry instead of a fundamental human right. So the ACA, using ideas that originated with conservative think tanks, was structured to work with the private insurance industry, rather than to replace it. Controls were put on insurance premiums, particularly focused on ensuring that people with preexisting conditions wouldn’t be priced out; Americans who still couldn’t afford the premiums were eligible for government subsidies.
Republican cries of “death panels” and “rationed care” were always nonsense, as the clarity of hindsight now proves. Yet the GOP’s yearslong efforts to kill Obamacare were relentless. Red states like Missouri refused to expand Medicare, a key component of the program, even though the federal government would cover the cost. Reams of legislation and litigation attempting to kill it were filed perennially. The Trump administration, unable to formally end the program, yanked its advertising funding to make it less accessible to Americans. In real ways, the Republican Party did everything in its power to pull away the newly acquired health care coverage that millions of Americans finally had.
The recent silence from Republican politicians on this issue that previously obsessed over them indicates that even they understand the battle is over. The ACA has become an important resource in keeping Americans healthy, and the sky hasn’t fallen. Losing it now would be catastrophic. Voters should remember that as they go to the polls this fall.
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