Now that TrumpCare is Dead, Stop Lying

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For Trump, this has never been about improving our health-care system. Trump, who visibly had no idea how the ACA works or what was in the various GOP replacements, and who openly said he would sign whatever Republicans put in front of him, just wanted to boast of a “win” while triumphantly using Barack Obama’s signature domestic achievement as his own personal toilet paper roll.

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But this outcome, ironically, was good news not just for the United States, but also for untold numbers of Trump’s own voters, the low-income and aging whites who also benefited from the ACA’s historic coverage expansion. Trump’s voters were spared the destructive impact of his peculiar combination of ignorance, megalomania and sheer indifference to the fate of millions.

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If there is one thing I hope happens now, it’s that Trump and Republicans can shape their current response to the ACA around an acceptance of an idea that many of them have refused to acknowledge: that the ACA has effected positive change in the lives of millions, making American life more humane and just. The Medicaid expansion has expanded coverage to millions of poor people, many of whom no doubt never had coverage in their lives, and many deep in the heart of Trump country. The exchanges, for all their problems, have helped extend coverage to millions more, particularly people with preexisting conditions, who can now get robust insurance packages, and lower-income people who can now get coverage with the help of subsidies.

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many Republicans have also refused for years to tell the truth about the real-world impact of the law, or about what their own replacements for it would actually do. House Speaker Paul D. Ryan kept lying right up until the end, claiming the ACA is merely “collapsing and hurting American families.” Throughout, Republicans claimed endlessly that their solutions would not cut Medicaid and would leave nobody worse off, and that if millions were left uninsured, it would be by choice under the new reign of freedom they would usher in. Trump, too, hopes to sabotage the ACA under the guise of the lie that it is collapsing of its own accord.

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My point is not that Republicans should stop making arguments against the ACA or stop trying to move our health-care system in a conservative direction. Indeed, a genuinely bipartisan approach to reforming our health-care system could end up giving Republicans some deregulatory measures in exchange for GOP help in shoring up the exchanges and a GOP acceptance of the ACA’s coverage expansion. Some Republican health wonks are now calling on their party to adopt a similar approach. But for this to happen, we would all have to proceed from shared agreement that this coverage expansion — one fostered by government — has actually helped enormous numbers of people, even if it isn’t in the manner that Republicans had hoped.

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