Malice Is the Centerpiece of Trump's Agenda: Access to Healthcare Edition

With the constant barrage of news about Trump administration failures, many of them of deliberate design, commanding our immediate attention at seemingly every moment, the long-term consequences of that sabotage often escapes notice.

This should be a headline with sustained coverage in every newspaper and magazine, on every network news broadcast, on every cable news channel: U.S. Americans' access to healthcare is eroding again under Trump's presidency.

The Washington Post editors, under the blunt and accurate headline "Americans Are Starting to Suffer from Trump's Health-Care Sabotage" write (empahses mine):

The Commonwealth Fund, a nonprofit foundation focused on health-care issues, announced last week that the rate of working-age Americans without health insurance in the group's annual survey rose to 15.5 percent, up about three percentage points since 2016. Things are worse in the 19 holdout states, such as Virginia, that have refused to expand their Medicaid programs: The rate of uninsured working-age Americans hit 21.9 percent in those areas, up nearly six percentage points over two years. Nationally, the spike has been particularly bad at the modest end of the income scale, rising nearly five percentage points since 2016 for low-income, working-age Americans.

Obamacare critics regularly describe all problems as the inevitable result of a poorly designed law. But the numbers suggest that the critics' sabotage efforts are to blame. After impressive declines during President Barack Obama's second term, the fund found that the uninsured rate increased in both of the years Mr. Trump has been in office. During the campaign, Mr. Trump regularly complained that the Affordable Care Act (ACA) left too many Americans uncovered. The result of nearly a year and a half of Mr. Trump's leadership is 4 million people added to that group.

Obamacare was never perfect. But Commonwealth Fund analysts noted that, rather than fixing the law's problems, Republicans have done concrete things to worsen them. "These include the administration's deep cuts in advertising and outreach during the marketplace open-enrollment periods, a shorter open enrollment period, and other actions that collectively may have left people with a general sense of confusion about the status of the law," they wrote. "Signs point to further erosion of insurance coverage in 2019: the repeal of the individual mandate penalty included in the 2017 tax law, recent actions to increase the availability of insurance policies that don't comply with ACA minimum benefit standards, and support for Medicaid work requirements."

Surely, a significant part of this sabotage is driven by Republicans' desire to dismantle the signature achievement of Barack Obama, the nation's first Black president and most recent Democratic president. But equally as significant, at least, is the fact that subverting the federal government's role in providing services to We the People (especially certain We the People) is a driving force of conservatism.

Yes, this vile cruelty is happening during the Trump administration, and the blame should be laid at his doorstep. It should be shared with the rest of his party, though. Trump, after all, is comparatively new to politics; there are Republican officeholders who have been diligently working for decades to lay the groundwork for this sort of (non)governance.

It's important to hold Trump accountable. It's also important to remember and center, always, that Trump is not an anomaly of Republican politics, but its inevitable endgame.