In the weeks that followed Donald Trump’s election, people- many of them Trump supporters, discovered that Trump’s vow to get rid of Obamacare actually meant that they personally would lose their insurance. They had not quite realized that big government overreach was actually saving their lives.  They started voicing concern and showing up at the offices of their elected officials- the ones they had elected to repeal Obamacare.

But it turns out those representatives were never really interested in the concerns or health of their constituents.  If they had been, they would have been working to fix the problems of the ACA, not repeal it.

Don’t get me wrong, the ACA was/is complicated and expensive. It would have been far cheaper to pursue a single payer system- extending the hugely popular (and now also threatened) Medicare program to all Americans. But that was simply never a realistic possibility give Republican opposition.  Obamacare was an offering to the Republicans: a market based solution that, however clunky, offers millions of Americans health insurance.  It was, after all, the REPUBLICAN plan from the 90’s.

One major reason that Americans were unhappy with Obamacare was the skyrocketing rates.  It should be pointed out- and strangely, almost never is- that those rate hikes were the result of private business decisions.  The dreaded Federal government did not raise Americans’ insurance rates. The executives at health insurance companies like Aetna, Humana, United Healthcare and Blue Cross Blue Shield did.

While claiming Obamacare was a financial catastrophe which necessitated raising premiums, these companies were actually raking in record profits. It was insurance companies that were price gouging Americans. While Republicans screamed about Obamacare and government overreach, it was private business that was fleecing Americans and the US government.

It never made sense for insurance companies to be so angry about Obamacare. The law actually required everyone to purchase their product.   So why did they complain? For Humana, the reason seems to be a ploy to get out of an anti-trust case against them.

Perhaps for many companies it was just about maximizing profit.  They wanted to raise rates and retain the right to exclude people with pre-existing conditions. At this point you may say, “but the Republicans have promised that under their plan, Americans can still get insurance even with pre-existing conditions.”

Don’t be fooled- what Republicans are actually saying is that everyone will still have ACCESS to health insurance. You see, Obamacare provided insurance.  The Republicans will provide access. That’s a rhetorical slight of hand. We all currently have ACCESS to buy yachts and private planes. Very few of us have the ability to do so. Thus, under whatever plan Republicans suggest, insurance companies may be required to offer you insurance if you have a pre-existing condition, but that does not mean you will be able to afford that insurance.

Insurance companies can set the rate so high (200k a policy) that you cannot actually afford coverage. This is a shell game. The reason the ACA had an individual mandate was because it was the ONLY way to ensure that insurance companies could cover pre-existing conditions. Healthcare is complicated. The ACA has/had many problems- but the answer was to reform and refine.

Instead, as they rush headlong into repealing the ACA, Republicans are ensuring that lot of people are going to lose their insurance. A lot of people are going to get inferior coverage. And a lot of people are going to get sick, go into bankruptcy, and some will die because of repeal.

The silence about the role of insurance companies in our healthcare system is not new. When the Tea Party launched its assault on Obamacare in 2010, we heard scary stories of government death panels.  What always infuriated me about this was that those “panels” already exist.  Those panels take place in the boardrooms of insurance companies nationwide where they decide which procedures, treatments and medications get covered and which don’t.  What we don’t like to admit is that resources are finite, and whether you are a private business or a government agency, you must make hard choices about where you spend your budget.

With Obamacare, there was at least some accountability. You could lobby your government to allocate resources differently- making life better for you and others who have the same conditions.  In the unregulated days of old, you had no seat at the table.  You had no recourse. Decisions were made by private industry about your health and you had limited ability to argue for your life.

The great irony in all of this is that if Republicans would allow for a single payer government system, they would actually help businesses.  By freeing private industry from paying for health insurance, Republicans could help businesses and American citizens, all while bringing down healthcare costs.

But this was never about the health of Americans or about producing a better healthcare system. Republicans must own that they either a) just couldn’t support anything that Obama proposed- even if it was good for the country (and was their idea in the first place) or that b) they actually have no interest in making sure Americans get the medical care they need.