Affordable Care Act
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The governor of Ohio asks some urgently important questions:

“We are now able to provide health insurance to 700,000 people,” said Ohio’s [John] Kasich, who circumvented his state Legislature to enact [Medicaid] expansion in 2013 and who was the sole GOP presidential candidate in 2016 to defend that portion of Obamacare.

“Let’s just say they just got rid of it, didn’t replace it with anything,” he said. “What happens to the 700,000 people? What happens to drug treatment? What happens to mental health counseling? What happens to these people who have very high cholesterol and are victims from a heart attack? What happens to them?”

The answer is that many of them get sicker and a lot of them experience premature death. Countless others will live with the anxiety that they or their loved ones will suffer that fate.

But I have an additional question.

Why did we give these 700,000 people access to health care in the first place? What were we trying to do? Were we trying to lower the quality or increase the price of health care for everyone else? Were we trying to turn this country into a European dystopia? Were we pursuing an ideological jihad against the American Way?

John Kasich is hardly a moderate in most policy areas, but he does understand the moral imperative to make sure the citizens of Ohio don’t needlessly get sick or die. He knows that just on the opioid crisis alone, the state can hardly afford to lose the access to treatment that Obamacare provides.

Paul Ryan ought to know the same things, but he’s paid not to understand them. He’s willing to look a man straight in the face and lie to him about what will happen if they repeal Obamacare and don’t replace it with something that gives people the same or better access to health care.

For decades, our political leaders were unable to come up with any plan to cover people who couldn’t afford or were refused access to health care. That our citizens were constantly getting sick and dying prematurely as a result was considered a crime by Democrats and some kind of Darwinian justice by Republicans. That people were repeatedly denied care that they had every reason to believe they had paid for wasn’t something the GOP particularly cared about. That more and more citizens were priced out of insurance every year by rampant premium inflation wasn’t considered a moral crisis.

So, when the Democrats finally gathered enough political power to address these problems, they came up with the best solution they could given the constraints placed on them by monolithic Republican opposition and the power of the lobbying groups arrayed against them.

The results were as imperfect as you’d expect, especially considering that the plan was undermined by a conservative Supreme Court that weakened the Medicaid expansion, and by Republican governors who refused to participate, and by a Republican Congress that worked overtime to cause premium hikes.

Nonetheless, the plan has covered an estimated 20 million people who would not have insurance without the law, bringing the uninsured rate to an historical low. Meanwhile, while co-pays and deductibles have continued to go up significantly, the rate of increase in premiums has lowered enough to more than compensate for it. In fact, health care inflation is at the lowest rate in decades. The law also helped extend the solvency of Medicare into the 2030’s.

For the Republicans governing states that did expand Medicaid, they have a message for Congressional Republicans:

Arkansas’ [Asa] Hutchinson told House GOP leaders Wednesday that he wants to keep Obamacare’s federal funding boost for expanded Medicaid — but have more flexibility to run the program as he’d like.

Michigan’s [Rick] Snyder says he defended his state’s Medicaid expansion to Trump’s team and the state’s congressional delegation.

“Massachusetts believes strongly in health care coverage for its residents,” [Charlie] Baker wrote in a letter to House Republican leadership on Wednesday.

And Nevada’s [Brian] Sandoval, in a letter that outlined at great length how Obamacare has benefited his state, warned Republicans about gutting the law.

“You must ensure that individuals, families, children, aged, blind, disabled and mentally ill are not suddenly left without the care they need to live healthy, productive lives,” Sandoval said.

These governors will have severe political and budgetary problems if the congressional Republicans and Donald Trump take away Obamacare. They also can’t defend it morally, which is a very important point.

They may have some influence over what happens. They probably have more credibility and leverage than anyone else.

Right now, they seem to be the best advocates for reality-based thinking that are available.

Of course, reality is its own advocate, and the Republicans and reality are about to have a rendezvous when they sit down to try to actually legislate a replacement.

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Martin Longman is the web editor for the Washington Monthly. See all his writing at