Trump worries about Florida if he kills health care law | Randy Schultz

If President Trump’s actions regarding Ukraine are indefensible, so are most of his domestic policies -- especially as they might affect Florida.

Trump has a terrible record on the environment and climate change, which is this state’s existential issue. But let’s not forget health care. Even the administration is running away from that record.

Very soon, the 5th U.S. Circuit Court of Appeals will rule on the lawsuit challenging the Affordable Care Act. Attorneys general from 18 states -- including Florida -- contend that because the 2017 Republican tax bill ended the requirement that Americans buy health insurance, it rendered the entire ACA unconstitutional.

Credible legal scholars consider the argument absurd. Republicans, though, judge-shopped and found a Texas jurist with a history of hostility toward the law. During oral arguments in July, two members of the three-judge appellate panel -- appointees of Trump and George W. Bush -- sounded sympathetic to the GOP’s case.

Whichever side loses will appeal to the Supreme Court. On that schedule, a ruling would come in the middle of the 2020 campaign. If Trump’s two appointees join a majority that overturns the law, here’s what Republicans would face:

About 10 million Americans could lose health coverage through the ACA exchange. Roughly 1.8 million of them live in Florida. No state has more signups;

Nearly 13 million Americans could lose health care coverage through Medicaid expansion under the law. Thirty-six states added that coverage. Florida didn’t;

Roughly 2.3 million young adults could lose coverage that they get until age 26 under the law through their parents’ policy;

Some of the 52 million Americans who have pre-existing conditions could lose coverage if they buy policies on the individual market.

If that happens, Trump and the Republicans have no plan. So as the Washington Post’s Health 202 blog recently reported, Trump officials plan to stall. If they lose in the 5th Circuit, they might ask for a hearing before the full court. If they win, they might ask to stay the ruling.

Trump doesn’t want to run as tens of millions of Americans deal with the consequences of the law’s demise and correctly blame him. Democrats stressed health care last year when they retook the House.

It’s true that the ACA has not lowered the overall cost of health care. The goal, however, was to start slowing the trend. In that sense, the law has succeeded.

In 2010, when Congress passed the law, the Centers for Medicare and Medicaid Services predicted that nationwide Medicaid costs in 2019 would be $794 billion. In fact, they were about $630 billion.

Medicare spending for 2019 is about 18 percent below 2010 projections. Private health care costs are down roughly six percent from estimates of a decade ago.

In addition, evidence is emerging that the law has made the country healthier. People who got coverage under Medicaid expansion are seeing doctors more often and learning earlier about such issues as high blood pressure, for which they now can afford medicine.

Michigan has studied the effect of the law on the 650,000 working poor who obtained coverage under Medicaid expansion. John Ayanian, director of the University of Michigan’s Institute for Healthcare Policy and Innovation, told the Post that “the weight of evidence is on the positive side.” All that progress would stop if the courts kill the law.

Florida Republicans have done their share to cripple the ACA. Former Gov. Rick Scott and the Legislature made health premiums off-limits from insurance regulators during the first law’s first two years. Sen. Marco Rubio amended a spending bill to cut subsidies to ACA insurers that he falsely called a “bailout.”

For his part, Trump has cut money to advertise the ACA exchange. He has allowed cheaper, low-coverage plans to compete with those on the exchange.

Yet the ACA remains resilient. Floridians who buy coverage through the exchange will pay no more for premiums in 2020.

After routinely calling the law “a disaster,” Trump said in June that it “at least works adequately now.” Naturally, he took credit for the improvement.

The Republican strategy on the ACA used to be Repeal and Replace. Now it’s Repeal and Retreat. And don’t worry about the wounded.

Randy Schultz’s email address is [email protected]

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