Donald Trump had it right when he described health care in the United States with the phrase, “It’s complicated.” And now Republicans at both national and state levels are discovering how complicated it is.

President Obama’s significant legislative achievement, the Affordable Care Act (ACA), has survived a number of legal challenges and been the law of the land since 2010. It made major changes in a healthcare industry that represents 18 percent of the GNP, providing substantial benefits to a wide variety of Americans, including thousands of Virginians. The percentage of Americans with health insurance has risen dramatically. The law allows families to cover their children on their health insurance plans through age 26, and prevents insurance companies from discriminating against people with pre-existing conditions.  ACA established certain “essential health benefits” that must be included in all insurance plans, and provided an incentive for states to include more people in their Medicaid programs. It established a mechanism by which working families could purchase health insurance on “insurance exchanges” and receive tax subsidies to assist them in doing so.

Trumpcare threatens to undo many of these provisions, and, in the process, provide a major tax break to the wealthiest people in the United States; the Congressional Budget Office (CBO) says that the Senate bill cuts taxes by $1 trillion over 10 years, with one-third of that amount going to the 100 wealthiest families in America. This is not “repeal and replace;” rather, it is an example of “cut and redistribute.” [Read more…]