Voters in Oklahoma, where President Donald Trump won by 36 points in 2016, voted last week to accept the Affordable Care Act’s Medicaid expansion with a constitutional referendum.
The result, which will grant free and needed health insurance to 200,000 poor adults not currently covered because they have no dependent children or make more than the $8,900 annual state limit, is a stunning repudiation of Oklahoma Gov. Kevin Stitt. That Republican has pushed to make Oklahoma the first state to adopt a dangerous Medicaid block grant program favored by Trump and congressional Republicans.
The referendum result is also a slap at Trump as he renews a push to have the Supreme Court strike down the ACA. That could leave as many as 23 million Americans uninsured, about 12 million of them on Medicaid and another 9 million who get subsidies to buy policies. In the decade since the ACA passed, Republicans, including Trump, have never put forward their promised better, cheaper plan.
This pandemic has clarified a fact of medical spending: the federal government is the payer of last resort for health care needs, which means the taxpayers are. States and municipalities and hospitals that got hit with catastrophic medical costs related to the coronavirus got a federal bailout in the $2 trillion aid bill Congress passed, and they’ll need and likely get more.
That’s not new. The federal government, which has mandated since 1986 that hospitals cannot refuse health care to anyone who urgently needs it, already paid the majority of Medicaid costs. It also has programs to bail out hospitals burdened with treating patients who cannot pay. The ACA got a lot of these patients regular doctors, treatment plans and relief from chronic illnesses.
The ACA’s Medicaid expansion and subsidies were a far better solution than denying poor and low-income people regular and preventive care while guaranteeing them acute care. Republican-dominated states and their voters are increasingly accepting this fact. Oklahoma is the fifth state where voters have defied Republican leadership to accept the Medicaid expansion via referendum, and Missouri may become the sixth on Aug. 4.
The ACA is far from perfect, but ending it would decimate protections a majority of Americans support: guarantees of coverage regardless of preexisting conditions, the ability to keep adult children on parental policies until age 26, and forcing companies to sell only policies that cover all basic necessary medical costs among them.
And the need for and support of the ACA has increased as the pandemic drives unemployment and hospital admissions to horrid highs. Most legal experts, including many conservative thinkers, say Trump’s argument for overturning the ACA has little merit. Voters, even in Republican states like Oklahoma, increasingly agree.
Trump’s ACA attack is bad politics and bad policy. He and Republican leaders would be wise to drop this challenge. If they have a better way to provide health care to Amercians who need it, they ought to propose it. If they don’t, they’d be wise to leave well enough alone.
— The editorial board