No matter what one thinks about the legal basis for last Friday’s ruling by a federal judge in Texas striking down the Affordable Care Act — and we see it as a reckless decision, likely to be overturned — there is no doubt the law itself has proven powerfully effective. More than 20 million Americans rely on the ACA for health insurance, and with it, more financial security and better medical care.
It’s certainly more popular and more durable than what any of the Republicans who opposed its passage in 2010 or who have fought for nearly a decade to destroy it ever imagined. That includes Gov. Greg Abbott, who campaigned against the law, also known as Obamacare, in 2014 and again this year. Now he’s promising that if Friday’s ruling is upheld, Texas will be ready with a replacement. So determined to do the right thing, our governor is, he’s even promising not to wait until a final ruling in the case. He said Texas is talking with the Trump administration about waivers so it can opt out of Obamacare, no matter what the courts decide.
How cynical. Of course it’s prudent to plan for a backup if the ruling is upheld. If Obamacare is struck down, despite having been declared constitutional twice before by the Supreme Court, that could spell disaster for millions in Texas and beyond. But how much standing does a governor have in promising to do Obamacare one better when his own state ranks dead last for the share of adults and children without insurance?
Obamacare is working across the nation and in Texas, despite the yearslong campaign by Abbott and many others to weaken it. The best thing Abbott could do to improve access to health insurance in Texas is to do what so many other states have done and partner with the federal government to expand Medicaid. Texas doesn’t even need a waiver for that to work, just leaders with vision.
In 2010, America’s uninsured rate was just under 16 percent, according to Census Bureau estimates. By 2017, the share had fallen to just over 8 percent. Though 7 or 8 percentage points may not seem like a seismic shift, that drop has meant equipping tens of millions with the tools they need to prepare for medical emergencies and to get the medical care they need when they are ill.
The law has done more than add to the Medicaid rolls, too. Millions more have used partial subsidies to buy private insurance, which has been a boon for many insurers and for health providers, too. Even the share of workers on employer-provided plans has inched up. .
Obamacare has survived many tests in and out of court. It will likely survive this one. Republicans like Abbott should get busy trying to improve it, rather than replace it.