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Covid Makes Health Care an Even Bigger Nightmare for Trump

Max Nisen
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Covid Makes Health Care an Even Bigger Nightmare for Trump

(Bloomberg Opinion) -- As President Donald Trump struggles to confront racial injustice and an epidemic, his approval ratings and polling performance against Democratic rival Joe Biden are plunging. House Speaker Nancy Pelosi is tightening the screws with legislation focused on health care, a Trump weakness even before Covid-19.

A new bill, expected to pass Monday, would bolster the Affordable Care Act's individual insurance market by making subsidies under Obamacare more widely available and encourage more states to expand Medicaid. The legislation's cost would be offset by ambitious drug-pricing provisions that were part of a previously passed bill and would further reduce insurance premiums and drug costs for the entire country.

It's the first broad health measure to be put forward in a while, and the timing isn’t a mistake. It comes days after the Trump administration reiterated its support for a lawsuit headed to the Supreme Court that would strike down the ACA, an increasingly popular policy that’s now providing coverage for over 20 million during a pandemic. And while the bill is likely dead on arrival in the Senate, it will still be an effective political weapon.

Making individual health insurance more affordable, boosting Medicaid's crucial safety net, and cutting drug prices is an appealing policy goal at any time. It's particularly vital right now.

People often fall back on the individual insurance market and Medicaid when they lose access to employer-based insurance, as many have now amid the massive job losses caused by the economic shock of the pandemic. With Covid case counts surging in many parts of the country, the transition need to be as smooth as possible.

An additional 154,000 people signed up for insurance on healthcare.gov this year due to job loss , a 46% increase over 2019. That figure doesn't include 13 states, including California and New York, that independently run their insurance exchanges. Medicaid is proving to be an even more crucial backstop.  As of May, the program covers nearly a million more people in just 15 states that have reported updated enrollment data.

The pandemic-specific benefits of Obamacare expand beyond those who directly get coverage. Its popular protections for those with pre-existing conditions ensure that people who suffer long term complications from Covid can't be discriminated against by insurers in the future. It also limits bills for those that get sick and require extensive care.  More people are benefiting from the law and seeing the limits of employer-based insurance every day, and the number is likely to grow in the months to come, given the current trajectory of the pandemic.

Against that backdrop, the administration's continuing quest to eliminate the ACA is difficult to justify on a political or policy front. Even red states such as Idaho, Montana, and Utah have expanded Medicaid in recent years, and Oklahoma and Missouri may do the same via ballot initiative. Eliminating the law would contribute further to the yawning economic and racial health care disparities that have helped Covid hit communities of color so hard. Trump and congressional Republicans still haven't bothered to come up with an alternative plan. 

The Supreme Court likely won't decide on the ACA case before November. However, oral arguments in October may remind voters of the administration's priorities. Biden's campaign is likely to keep the issue fresh in their minds, using both Pelosi's bill and his own more ambitious proposal to expand coverage. 

The administration's long-running effort to gut the ACA helped Democrats win the House back in 2018. It's even more misguided now and likely to be even more damaging from an electoral perspective in November.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.

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