When the lifelong Republican Jeff Jeans recently questioned the House of Representatives Republican speaker, Paul Ryan, about the party’s healthcare proposals, Ryan probably expected him to oppose Obamacare.
However, Jeans, who was diagnosed with a treatable form of cancer aged 49, now relies on the insurance put in place after the 2010 introduction of Obamacare – formally known as the Affordable Care Act (ACA). So to Ryan’s surprise, he said: “I want to thank President Obama from the bottom of my heart because I would be dead if it weren’t for him.”
His story is far from isolated but following the spectacle of Donald Trump signing an executive order within hours of entering the Oval Office on Friday that directed government agencies to unravel the act, it is all the more poignant. Thanks to Obamacare 20 million more people had insurance in 2016 than in 2010 – many of them poor or on low incomes, but also people who couldn’t previously afford cover due to pre-existing medical conditions that made insurance policies prohibitively expensive. For many, Obamacare was the first time they had ever had health cover. For some it was also the difference between a health condition being treated or not, or bankrupting a family.
In Britain, reports of families being left destitute in the US because they couldn’t afford private health insurance have been rightly judged as scandalous and prompted many people to fear any hint of NHS privatisation. While the NHS is currently under enormous pressure (courtesy of the austerity-obsessed Tories), including bed shortages, the crisis in A&E and cancelled operations, to say nothing of social care cuts making a bad situation worse, access to healthcare is still seen as a fundamental right for all.
In the US, where access to even basic healthcare has historically been seen as a luxury not a right, it’s easy to understand why so many embraced Obamacare. It was hardly a flaw-free initiative, but it was a start.
Even though Trump has repeatedly dismissed the ACA as a disaster and Republicans have ratcheted up efforts to dismantle the programme (they’ve been trying since its inception, saying it’s “big government” gone mad), the latest surveys show Obamacare is growing in popularity. Half of Americans polled by NBC and the Wall Street Journal this month said the law was working well, while the same proportion had little or no confidence in Republican proposals to change it. To a degree this reflects how politically split the country is, but as NBC News pointed out, 45% of people said they thought the law was a good idea – more than at any time since the question was first asked in 2009. Judy Solomon, the vice-president of health policy at the Center on Budget and Policy Priorities, says this may be down to more people having first-hand experience of the ACA. “I think people are really beginning to understand what this thing is and what it does and they don’t want to lose it.”
The Republicans say they would repeal key provisions while keeping others and then replace it later with something better. However, this month the non-partisan Congressional Budget Office (CBO) released an analysis of the party’s proposals from 2015 (the Restoring Americans’ Healthcare Freedom Reconciliation Act, which Obama vetoed) that painted a damning picture should this strategy be followed. Within a year of repeal 18 million people would lose their insurance, it found. The CBO also estimated that insurance premiums would soar by 20%-25% in the year following a dismantling of the law.
If the worst happens it’s hard to contemplate what people like Jeans will do. Rebecca Vallas, a director at the Center for American Progress, in a reference to Trump’s inaugural speech, concludes that its eradication would be “the real American carnage”. Josh Hoxie, a director at the Institute for Policy Studies thinktank, says the impact on lower-income people, and on inequality more broadly, would be dramatic, and not just in terms of access to healthcare. He points to research showing that dismantling the ACA would result in 7 million low-income people becoming instantly poorer because they stand to lose premium tax credits included in the ACA. Meanwhile – and perhaps illuminating why Republicans may be so keen to overthrow Obamacare – the same research found that the 400 richest Americans would get a combined tax cut of $ 2.8bn (£2.3bn) as a result of repeal.
Whether it’s austerity in the UK or lining the pockets of the rich in the US, healthcare is about political choices. The wrong choices can be devastating, which is why they should be fought at every opportunity.
Mary O’Hara writes on social affairs and is the author of Austerity Bites
What links the NHS and US healthcare? Political choices | Mary O’Hara
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