By Stacy M. Brown
Black Press USA Senior National Correspondent
Republican power in this country has chosen cruelty as policy. It is not an accident. It is not a mistake. It is a decision.
The decision now is to rip out the federal subsidies that have made the Affordable Care Act more than a slogan and turn it back into a luxury item for the rich. Years of quiet sabotage and loud lies are coming to their natural endpoint. They are preparing to take health care from tens of millions of people and call it freedom.
This is not only about money. It is about a man who walked into the White House vowing to erase the work of the first Black president. From the birther lies to the nightly chants about “repeal and replace,” Donald Trump built his political life around tearing down Barack Obama. Analysts laid it out years ago. The law was called “Obamacare.” That name, that legacy, that image of a Black family in the White House turning health care from charity and chance into a right drove him wild.
So, he hacked at it from every angle. Cut outreach. Cut enrollment help. Pushed junk plans. Tried to strangle Medicaid expansion. Took every inch of executive power and turned it toward undermining a law he was sworn to enforce.
Now he and his party are walking the country to the edge of a cliff. Inside a closed Republican meeting, House leaders stood up and made a case not for saving people from ruin but for letting the enhanced ACA subsidies die on schedule. Those subsidies, about $35 billion a year, keep premiums for a basic “benchmark” Obamacare plan at no more than 8.5 percent of a family’s income. When that money vanishes at the end of the year, an estimated 22 million people will not just see an uptick in costs. Some will watch premiums jump by thousands of dollars a month.
They are not talking about how to protect those people. They are talking about how to walk away and blame someone else. Senior Republicans already admit the cliff is coming. They admit they have no serious replacement ready. One of their own from a vulnerable district called it “ripping the rug out.” The reaction in the room was described as average. Not outraged. Not alarmed. Just average.
You have to understand what those subsidies are before you can grasp what this moment really means. The Affordable Care Act did not rain down free insurance. It built a Marketplace where people without job-based coverage could buy plans and then added tax credits to keep those plans within reach. Advanced premium tax credits go straight to the insurer and cut the bill before it ever lands in a family’s mailbox. Cost-sharing reductions lower deductibles and copays, so a trip to the doctor does not become a trip into debt. About eight in ten people who buy ACA coverage qualify for some sort of help.
Those tools turned a cruel equation into something close to survivable. Instead of choosing between rent and an asthma inhaler, between childcare and a mammogram, people could finally carry a card that meant the hospital had to see them as a patient and not as a bill collector’s target.
Trump and his allies want to break that equation on purpose. They do not hide the plan. They call the law a failure, then move to destroy the very subsidies that make it function. When it collapses under that pressure, they will point at the ruins and say they were right all along.
The excuse now is a new promise that sounds generous until you listen with your eyes open. They say they want to “send the money directly back to the people,” through health savings accounts, flexible spending accounts, or maybe even cash. They say they do not want to “give money to insurance companies.” Never mind that those payments keep premiums down for real people in real time. Never mind that health savings accounts help those who already have spare cash and leave those living paycheck to paycheck with an empty tool they cannot afford to use.
In truth, this is not a debate about bureaucratic routes and fiscal instruments. It is a question that has haunted this country since its birth. Who deserves to live? Who deserves to see a doctor when their chest tightens, or their child spikes a fever? Who deserves chemotherapy instead of a prayer?
The answer from this Republican Party, led by this president, is as plain as his social media feed.
“The only healthcare I will support or approve is sending the money directly back to the people,” Trump wrote on social media, declaring that he will not accept a continuation of the ACA structure that routes those funds through the system that actually pays the bills. “Congress, do not waste your time and energy on anything else.”