It’s already clear how the 2020 election campaign will be waged. Republicans will claim, falsely, that Democrats want to take away your hamburgers. Democrats will assert, truthfully, that Republicans want to take away your health care.

I guess we’ll see which argument wins.

On Monday, the Trump administration adopted a new position on a lawsuit over the Affordable Care Act, telling a federal appeals court that it now supported the complete elimination of the law, which has made health insurance available to many Americans who wouldn’t have it otherwise.

We have a very good idea what would happen if this lawsuit were to succeed. Around 20 million Americans would lose health coverage.

While President Donald Trump reportedly thinks that attacking the ACA will please his base, the greatest devastation would actually come in states that strongly supported Trump in 2016, believing his promises that he would defend health care. In West Virginia, for example, 160,000 people — 11 percent of nonelderly adults — would see their health insurance snatched away.

Trump and his defenders are claiming that this wouldn’t happen, that they’ll unveil a great health care plan to replace Obamacare. But Republicans have been saying that for nine years, ever since Obamacare was enacted, and have never delivered. They don’t have a plan, and they never will.

So Republicans want to take away your health care. Democrats, on the other hand, want to make it better and cheaper — not just in the long run, with some kind of radical health reform, but right away.


The day after the Trump attack on Obamacare, House Democrats released a plan to enhance the ACA, mainly by expanding the subsidies that limit the share of income families have to spend on insurance premiums. Lower-income families would end up paying less; middle-class families whose income is now just a bit too high to qualify for subsidies, yet still find the cost of insurance hard to bear, would be brought into the system and see major gains.

We don’t yet have estimates of how many Americans would gain coverage under this plan, but it would be a lot of people. The House plan would bring national benefit levels roughly up to levels in Massachusetts, which has had a more generous ACA-type plan in effect since 2006 — and where the percentage of nonelderly adults without insurance is a third of the national average. Achieving Massachusetts-type results nationally would mean around 15 million more people gaining coverage — probably unrealistic, but an indication of how big a deal this could be.

All of this would cost money, probably several hundred billion dollars over the next decade. What should Democrats do if Republicans ask how they plan to pay for it?

The answer is, laugh in their faces. The GOP recently rammed through a tax cut, disproportionately benefiting the wealthy, that will probably cost $2 trillion over the next decade — with no offsetting savings. Enhanced health care could easily be paid for by rescinding just part of this big giveaway. If Republicans won’t do that, it’s not Democrats’ problem.

And if this proposal’s advocates are willing to be relaxed about funding, as they should be, the plan is basically ready to go. If Democrats take the Senate and the White House next year, they could enact the plan, easing the burdens of millions of Americans, almost immediately.

What about progressive hopes for a more fundamental health care overhaul? Rep. Alexandria Ocasio-Cortez, D-N.Y., got it exactly right: While still calling for hearings on “Medicare for all,” she declared herself “happy to support any provision that strengthens the ACA and plugs some of the gaps that we’re seeing.” (So far, Sen. Bernie Sanders, I-Vt., has refused to support the plan. Let’s hope he walks that back.)


So Democrats have a realistic plan to expand health care, while Republicans are still pursuing their jihad against Obamacare. The question is why.

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We have, after all, gone well beyond the point where trying to kill the ACA was a smart if cynical political strategy. The act has become increasingly popular since Trump took office. Health care was central to the 2018 midterms, and 75 percent of voters who considered it the most important issue voted Democratic.

So why can’t the GOP just cut its losses and accept that Obamacare has become part of our social fabric? After all, there was a time when people like Ronald Reagan insisted that Medicare would destroy American freedom; these days Republicans pose as defenders of the program (even if they’re still trying to undermine and privatize it on the sly).

Well, political scientists have some interesting thoughts about the reasons the GOP won’t just throw in the towel on the ACA. But details aside, modern Republicans just hate the idea of using public policy to help Americans get the health care they need, even when people’s inability to get insurance is a result of pre-existing medical conditions over which they have no control.

If this seems remarkably cruel, that’s because it is — and there’s no sign that this attitude will change. In today’s GOP, cruelty toward the most vulnerable is a pre-existing condition.