Why Donald Trump and the GOP Can't Repeal Obamacare

After Donald Trump campaigned for the presidency on the promise to repeal and replace Obamacare with "something terrific," his administration has just released a set of tweaks to the health care law--and those tweaks all favor the insurance industry over ordinary Americans.

The Affordable Care Act (ACA), which the GOP gleefully dubbed Obamacare, is clearly not good enough to serve all Americans well. But it is such a major improvement over the industry-dominated status quo of eight years ago that, as Nicholas Kristof of The New York Times succinctly wrote, "It is both unpopular and saves lives."

Having perhaps realized that many of his own supporters rely heavily on the ACA, Trump has postponed repealing it and instead has made changes that "insurers have long pushed for," according to The Hill. These include cutting the enrollment period in half in order to "cut down on sick people gaming the system," whatever that means.

Leading up to the announcement of the changes, thousands of Americans in cities across the country, angry about an ACA repeal, have packed town hall meetings held by their congressional representatives. On its surface, the movement is reminiscent of Tea Party activists blasting Democratic lawmakers in 2009 while screaming about so-called "death panels"--a non-existent aspect of the law made up to elicit negative sentiments. How is it that eight years ago so many Americans were upset about upending a barbaric status quo and replacing it with a policy they considered too "socialist," yet today they are upset about losing the life-saving, if still flawed, replacement?

One simple answer is that in 2008, conservative activists were mobilized by the election of the nation's first black president and saw opposition to his health care reform act as the perfect way to lash out at him. Now, with Trump in office, liberal and progressive activists upset over Trump's victory are mobilizing against his promise to repeal the law. But it's not that simple. While some news media have dismissed this year's town hall activism as an expression of liberal anger over Trump's presidential win, many who have shown up to confront their representatives truly are worried about losing newly acquired, life-saving health insurance.

Eight years ago in the pre-Obamacare era, I met a woman who had survived cancer at a time when the health insurance industry was barely regulated. While she had employer-provided private insurance through Blue Shield, the insurance company refused to pay for the treatment that her doctors said she urgently needed to combat her stage-four breast cancer. "I believe that Blue Shield HMO was writing me off because they thought I was too sick [to survive] and that it was too costly to pay for these treatments," she told me. So she paid $15,000 to have surgery and $3,600 a month for medications, all out of pocket. If she had not chosen to go into debt for the treatments, she said, "I don't know if I'd be here today."

While reporting from the Women's March in Los Angeles on January 21 this year, I met a young woman holding a sign that read "Save Obamacare, It Saved Me." She also had been diagnosed with breast cancer. Despite having private insurance, the out-of-pocket cost of her diagnosis alone was $6,000. Because she was unable to work during her cancer treatments, she became eligible for subsidized insurance coverage thanks to the ACA. That made health care affordable and enabled her to receive the treatments that have kept her alive. Although Obamacare still does not keep premium costs low enough or coverage broad enough for many Americans, the real-world experiences of beneficiaries are a testament to its importance.

Today, about 20 million previously uninsured Americans now have coverage thanks to Obamacare. White working-class Americans have been among the greatest beneficiaries of the law. In fact, it is safe bet that there is a large overlap between those people who gained health insurance under the ACA and those who voted for Trump.

There is a strain of self-righteous pride among many Americans who like to think their achievements are solely their own. It is the persistent myth of American meritocracy that would have use believe we all can make it in this nation if we lift ourselves up by our bootstraps; ergo, those who fall through the cracks do so because it is their own fault.

Americans defending Social Security and Medicare were among those who denounced the ACA, as revealed by the photos of these activist signs from 2009. Those who have benefitted from programs such as Medicare but hate the idea that they are dependent on a taxpayer-funded program are lying to themselves and us. It should shock us to learn that today nearly one-third of Americans do not realize that Obamacare, which they claim to hate, is the same as the ACA, which they might rely on and love. But of course, this sentiment is just another manifestation of the uninformed demand that the government stay out of Medicare.

In 2009, at a congressional town hall meeting, I spoke with several angry Americans who denounced the ACA. Well over a thousand people had shown up to the event organized by Rep. Adam Schiff in Alhambra, Calif. My conversation with one man highlighted the lack of understanding among so many Americans who hate the idea of a "government handout" until they actually use it and count on it.

The man held a sign saying, "I pay for mine, you pay for yours," and he asserted that "if you want health care, you pay for it." When I asked, "What about police protection?" he defended it saying, "Well, we all pay for that, including national security." I asked him to explain the difference between everyone chipping in for health care versus national security, and he said that police protection, "keeps me alive, keeps me safe from my enemies."

"Health care doesn't keep you alive?" I asked, unable to believe I was positing such a question. He said, with a straight face, "Hell no. I take care of myself." The man seemed to have no problem with the enormous profits that health insurance companies had reaped from denying people coverage. He said, "So what! So what! So do athletes, so do movie stars." Eventually he grew suspicious of me and shouted, "Are you anti-capitalist? You're a socialist! Get outta here with your microphone, you're a socialist!" Before I could continue to probe him over the government-funded programs he likely relied on without realizing it, he had walked off in disgust.

Such a mental disconnect continues to be commonplace, particularly among conservative Americans who have convinced themselves they have no need of government assistance. An important series of interviews with Trump voters by revealed that many beneficiaries of the ACA were unaware of the role of the government in the current system. One Kentucky woman said, "I didn't realize that the government was subsidizing my health insurance."

Many Trump supporters bizarrely turned a blind eye to Trump's repeated and vocal promises to repeal the ACA, because they assumed he wouldn't or couldn't do it. One such woman one who relies heavily on the ACA told Vox, "I guess we really didn't think about that, that he was going to cancel that or change that or take it away. I guess I always just thought that it would be there." Another woman who voted for Trump--and is actually well aware of what the ACA is because it is her job to sign people up for coverage--said she thinks the president is "going to replace it with something better."

But neither Trump nor the Republican Party seems to know how to replace Obamacare. A simple repeal would take us back to the days of insurance companies denying coverage to masses of Americans because of "pre-existing conditions," among other things. Many people believe the only way to replace the ACA with something better would be to switch to a "single-payer" plan, which is essentially Medicare for all. One can only imagine the howls of protests among conservative voters who would denounce such an idea until they actually tried it and benefitted from it.

But Republican lawmakers would never expand a social program, given that the mission of the GOP is to dismantle as many tax-funded safety nets as possible. Two senators, Bill Cassidy (R-La.) and Susan Collins (R-Maine) presented perhaps the most concrete replacement plan when they introduced a bill to replace Obamacare with ... Obamacare. According to Cassidy, "If you like your insurance, you should keep it. ... [Consumers] could opt to stay in Obamacare or they could opt for no federal help. So, California and New York, you love Obamacare? You can keep it." Trump's recently proposed regulations also are designed to preserve access to Obamacare, but they will increase benefits to those who need them least: insurance companies.

Several other Republican ideas, including one that Trump proposed during his campaign, simply give the insurance industry the right to deny coverage to people who might require expensive care--which is, in large part, how things existed not too long ago. Analyses of such plans conclude that they would result in roughly 21 million people losing health insurance coverage--which is about how many people gained coverage through Obamacare.

It would be funny, if real people's lives and well-being were not at stake, that those Republican members of Congress who take advantage of ACA-enabled government subsidies for their own health care plans essentially have painted themselves into a corner over their hysterical denunciations and their relentless attempts to repeal the ACA. It is no wonder that Trump has decided to buy himself time by postponing his campaign promise until next year, despite wasting no time in fulfilling most of his other pledges with terrifying swiftness. Perhaps he is hoping that Americans will conveniently forget about his ACA denunciation altogether. After all, he and his party have won support by relying on voter amnesia and a pervasive lack of critical thinking about the role of government and how it benefits people.