Since the Republican Congress failed to repeal and replace the Affordable Care Act (ACA), or Obamacare, over the last nine and a half years, including the first 18 months of the Trump presidency, there is widespread confusion and anger in  the public as to what is really going on in U. S. health care.

Trump issued an executive order in October 2017 intended to hasten the demise of the ACA. It called for government agencies to expand association health plans, expand marketing of low-cost barebones health plans of less than one year, increasingly shift responsibility for the burden of health care to the states, and encourage wider use of health reimbursement accounts (HRAs) by employers for their employees. None of these will improve access to affordable health care. Even those already covered by Medicare and Medicaid were worried about threatened cutbacks and increased costs as Congressional Republicans passed  their December 2017 tax bill that slashed “entitlement” funding to help pay down the 1.5 trillion deficit.

As columnist David Leonhardt observed:  TrumpCare has begun, not through legislation but through executive action . . . In doing so, it has both the short-term goal (have the federal government do less to help vulnerable citizens) and a long-term goal (sabotage ObamaCare, so that Congress can more easily repeal the law.) (1)

The ACA has been sabotaged and undermined by past and ongoing actions of the Trump administration to the extent that Trump and the Republicans now own TrumpCare. Lies have pervaded this unstable period under the false cloak of improving health care. With the repeal of the individual mandate as part of the 2017 tax bill, Trump bragged:

In this bill, not only do we have massive tax cuts and tax reform, we have essentially repealed ObamaCare, and we’ll come up with something that is much better. ObamaCare has been repealed in this bill. (2)

Chaos reigns throughout our increasingly expensive, fragmented, and dysfunctional health care system. Corporate mergers and profits are the order of the day, with health care becoming less affordable and less accessible. Private health insurers are dictating the terms of the unfettered marketplace as Americans continue to lose choice of physicians, other providers, and hospitals in restrictive networks subject to change at any time. Some insurers are exiting the market while others are raising premiums by more than 50 percent in a number of states. Family budgets are strained to the limits as many patients forgo necessary care, have worse outcomes if and when they finally get care, and often have to choose between food and medications. While all this is going on, health care stock prices have gone up almost four-fold since the ACA was enacted in 2010, compared to 116 percent in other sectors.  (3)

According to the latest polls by the Wall Street Journal/NBC News, health care is the # 1 issue among voters across the political spectrum, even above the economy. (4)  The Pew Research Center found in January 2017 that 60 percent of Americans felt the government should be responsible for ensuring health care coverage for all Americans. (5) A recent poll by the Kaiser Family Foundation found that one-half of respondents believe that the ACA’s marketplaces are falling apart. (6)

In this series of blogs over the next three months, I will try to give voters a better understanding of the threats of TrumpCare to their own health care and to consider their options during the coming 2018 and 2020 election cycles.

Adapted in part from my forthcoming book, Trumpcare: Lies, Broken Promises, How it is Failing, And What Should Be Done and the recently released pamphlet, Common Sense about Health Care at a Crossroads in the 2018 Congress

visit: http://www.johngeymanmd.org