As voters make up their minds about this fall’s mid-term races, they may wish to burn into their memories how the Trump Administration has dealt, so far, and especially in recent days, with government social programs that have huge effects on Americans’ health and lives.
Take, for example, the late-week, late night announcement by the U.S. Department of Justice that it will decline to defend yet another part of the Affordable Care Act, as 19 states, most red and led by Texas, attack Obamacare in the courts. The legal aspects of this decision will keep lots of law degree holders and their kindred men and women in black robes arguing, heatedly, for a while. There also may be huge political smoke clouds.
But keep in mind this basic fact from the actions by the Justice Department led by Attorney General Jeff Sessions: The nation’s crack legal team is asserting that it is unconstitutional for the ACA to bar insurers from declining coverage due to preexisting conditions.
Whether this crucial Obamacare protection stands or not will be decided by the courts. Many think that there will be a prevailing and opposition argument from 15 other states, led by California, that have interceded and asked the courts to sustain the ACA, including sections dealing with preexisting conditions under the act’s “guaranteed issue” and “community rating” provisions.
Republican lawmakers were left scrambling to try to argue that, well, yes, they voted to repeal the ACA, and, as part of the sprawling tax cut package they ended Obamacare’s key, individual mandate requiring Americans to show they have health insurance. But, somehow, counter factually, GOP lawmakers insist they want to preserve the ACA’s preexisting conditions protections.
Still, can voters ignore that the president’s reversing on his campaign position that he would leave undisturbed how the ACA deals with preexisting conditions? Will he, counter-factually, create out of whole cloth a contention that he is still supporting this important protection, even as Justice makes a lie of this position in its court filings?
Do voters need late-night comedian Jimmy Kimmel to remind them, yet again, how not just the poor but also middle-class Americans can get gouged by insurers and medical providers if they’re denied and lack health coverage because big, wealthy insurance companies get to decide again who qualifies for their increasingly costly products and services? Will President Trump kick as many as 1 out of every 2 Americans (an estimated 130 million of us) out of health coverage due to their preexisting conditions, including heart disease, cancer, arthritis, diabetes, and asthma? This aspect of health insurance was a nightmare before the ACA, with verifiable instances of seemingly healthy individuals denied coverage for athlete’s foot, acne, jock itch, and allergies treated with over-the-counter medications.
Meantime, new reports also can’t be overlooked as to how the administration has handled the Veterans Affairs department and the health services for millions of former service personnel and their loved ones, not to mention Medicare and Social Security.
Trump, with much fanfare and considerable and persistent back-patting about his support for the military, has signed the VA Mission Act, which the president and his supporters say will expand medical services for vets and their families, notably by allowing increased use of doctors and hospitals outside the VA system.
But even as he touts this medical care for vets, Trump’s officials have lobbied Congress hard against plans to fund it, arguing this should occur with cuts elsewhere in the $1 trillion-plus federal budget, the Washington Post reported.
The president’s mixed signals about the VA might be less problematic if the agency, confronting big and complex issues about its future and possible increases in privatization of its services, had stable leadership. Trump, of course, has failed to contribute to the giant agency and its big budget, first by undercutting its Obama-era hold-over (who had problems), then appointing out of the blue his personal physician to the VA’s top job. The president since has settled on Robert Wilkie, the undersecretary of defense for personnel and readiness who has been serving as the VA’s acting secretary, as his next choice to run the VA.
Wilkie, like any Trump official, faces a long period of fiscal struggles, as the GOP-dominated Congress and Trump enacted a $1.5 trillion tax cut that will drain Uncle Sam’s coffers for a long time, and create huge and stressful fights to determine which programs get funded and at what levels.
As the Washington Post has pointed out with the big, central, and expensive social support programs of Medicare and Social Security — both of which, their trustees say, are experiencing funding shortfalls that may affect their services sooner than expected — Trump and the GOP have turned the spigot on their revenue but not their spending.
The powerful AARP, representing the interests of tens of millions of seniors, is cautioning against a panic about the 2018 report by the independent trustees of the finances of Medicare and Social Security. The programs, key to huge numbers of older, poorer, and sicker Americans economic well-being and health, aren’t “going broke,” and they could be stabilized by reasonable, appropriate action. This might, for example, include increasing taxes on the wealthy to support social programs, rather than increasing the age at which beneficiaries could qualify for them (a move that wallops poorer workers in lower-skilled, manual labor jobs).
That hasn’t been the plan by the GOP or Trump, though.
In my practice, I see not only the harms that patients suffer while seeking medical services but also the struggles they go through to access and afford safe, efficient, and excellent medical care, without bankrupting themselves and their families, and especially with the necessary and welcome help of the VA, Medicare, Medicaid, and Social Security.
The fall’s mid-term elections are looking more important than ever, and we all need to watch not only what leaders say but what they do. We don’t want to wake up in a few months to find the exceedingly rich, with the Trump tax cut and more, have gotten even richer and fat-cat corporations have gotten fatter — while the rest of us are much poorer and sicker.