Just as he ended Roe vs. Wade by appointing justices he knew would overturn the precedent of protecting women’s reproductive rights, if elected, Donald Trump intends to repeal and replace the Affordable Care Act. 

In a speech last November, Trump promised to find “serious alternatives” to the ACA if elected. In language only he can master, Trump explained his position with eloquence, saying “Obamacare sucks.”

It would not be his first attempt. In 2017, Trump and his fellow Republican extremists fell a singular vote short of repealing the ACA. Trump has not forgotten and, just as a foundation of his 2024 campaign for the presidency is retribution against his political enemies, so, too, is re-visiting and killing the ACA.

Trump is not bothered in the least by the success of the ACA, a law now supported by six in ten Americans, but only 17 percent of Republicans according to the Kaiser Family Foundation (KFF). As recently as 2020, 77 percent of Republicans wanted the ACA repealed, turning back healthcare coverage, by 2023 estimates of 20 million ACA members and another 21 million Americans insured by the Affordable Care Act’s Medicaid expansion option.

If successful, Trump and his Republican acolytes would reverse the ACA benefits, including protection against denial of coverage for pre-existing conditions, allowing young adults to stay on their parent’s insurance to age 26 and ending the “job lock” that left individuals without insurance simply by leaving a job.

But even Republican desires to end the popular ACA do not fully reflect the Republican intent to harm the most vulnerable of Americans. Ten states, including Florida, where compassion goes to die, have refused to adopt the ACA opportunity to expand Medicaid benefits to 138 percent of the poverty level. Allowing millions more opportunities to have access to doctors and hospitals, Medicaid expansion is subsidized fully by the federal government. Yet, at no cost to the 10 states and the obvious benefit of expanding health care to the poorest of their citizens, these states remain opposed to the help available.

Worst still, expanding Medicaid offers protection for the at-risk rural hospitals in America by increasing payments for required emergency services. 

Yet still, our Republican friends refuse the cost-free benefits of Medicaid expansion. Over the last decade, two-thirds of rural hospital closings have occurred in states refusing Medicaid expansion, leaving many rural communities without access to local healthcare services.

The ACA is far from perfect. Health care costs have continued to rise above the rate of inflation and prescription costs have resisted fair pricing, but for the Biden administrations’ recent price protection on 12 of the most utilized prescriptions across the nation. There is much more to be accomplished.

But there are improvements overall in our health care, including annual well-carefree checkups, and this year, a $2,000 out-of-pocket ceiling for seniors on drug care costs. Silver Sneakers exercise programs have become common offerings on many Medicare Advantage programs, as have cash rewards for health-related purchases.

Trump’s intent is little more than another form of retribution for not getting his victory against the American people in 2017 by killing the ACA then. As for the Republicans who will willingly follow Trump’s direction, if given a congressional majority, what can be said, but that their recent congressional record reflects their indifference to their voters and the nation?

If elected, even should Trump fail to repeal the ACA, he could greatly damage the popular program. Some federal subsidies will expire in 2025 if not renewed, raising premiums, and causing many to find insurance once again unaffordable.

A successful Trump administration could end the ACA and the Medicaid expansion, exposing forty million Americans to the loss of their healthcare.

Trump is not worth the risk of his retribution success.

Jim Crawford is a retired educator and political enthusiast living here in the Tri-State.