Voters keep sending Republicans — in statehouses, Congress, and the White House — a clear message: Americans want affordable, accessible health insurance, most notably as offered under the GOP-loathed Affordable Care Act, and especially for the poor and working poor via Obamacare’s expansion of Medicaid.

This issue, if anything, may be rising in importance to the U.S. electorate as the Covid-19 pandemic rages without check and millions of Americans wrestle with pervasive joblessness that wiped out many people’s health insurance coverage.

Just weeks after voters in red Oklahoma backed a state constitutional amendment to expand Medicaid and narrowly defied the opposition of powerful GOP politicians who have dominated their state, residents of the “Show Me” state of Missouri showed up in force to approve Missouri’s expansion of the program coverage, by a 53% to 47% margin.

As the Associated Press reported, voters in conservative states, even those carried strongly by Trump in 2016, now have repeatedly rejected the Obamacare-Medicaid opposition that he and the GOP have campaigned on:

“The six states where voters have approved Medicaid expansion in the Trump years are Idaho, Maine, Missouri, Nebraska, Oklahoma and Utah. In Virginia, the legislature passed a Medicaid expansion after Democrats made political gains.”

A dozen states, eight of which were part of the Confederacy, have declined to expand Medicaid (see status of the expansion in Kaiser Family Foundation map above)— and several also have notably poor health care outcomes for their residents. Opinion polling in the non-expansion states also shows this political reality, the Washington Post reported:

“In May, the Kaiser Family Foundation (KFF) Health Tracking Poll found that in the states that had not accepted Obamacare’s Medicaid offer (which then included Missouri and Oklahoma), 66% favored expansion. ‘Even in red areas of red states, there is some support for expanding Medicaid,’ said Liz Hamel, KFF’s director of public opinion and survey research, noting that the May survey found 37% of Republicans favoring the step.”

A decade of failure in seeking ACA repeal

President Trump devoted the first year of his presidency to repealing Obamacare, an action that congressional Republicans have spent almost a decade laboring at, including with dozens of what became empty and repetitive naysayer votes. The late Sen. John McCain thwarted the Trump-championed Republican effort to repeal the ACA in a dramatic, middle-of-the-night vote, leading to lasting acrimony by the president for the GOP stalwart from Arizona.

Republicans, after passing a multi-trillion-dollar tax cut benefiting wealthy corporations and the richest Americans, later also repealed the so-called individual mandate penalty in the ACA. This became part of a long-shot legal challenge to Obamacare, a lawsuit that has advanced through an extreme GOP-appointed federal judge in Texas and a conservative appellate court. The U.S. Supreme Court has both expedited and slow-walked the challenge from a dozen or so GOP state attorneys general who argue that without the mandate, the whole of the ACA must fall. The case has been defended by a roughly equal number of Democratic state attorneys general. It may be argued before the high court in the fall term, with a decision potentially in the spring — after the presidential election.

Trump and the Republicans in Congress, though, have doubled down on backing an Obamacare repeal, even as popularity for the ACA helped Democrats recapture the U.S. House in the midterm elections and polling shows health issues paramount in the impending presidential election.

The never-appearing Trumpcare alternative

The president has promised and failed to deliver since 2016 his ACA alternative. He recently made a big deal out of announcing he would deliver his own health plan within two weeks — then failed to do so. He has talked about issuing an executive order to protect consumers, so insurers cannot decline to offer then health coverage due to pre-existing conditions. That, of course, is one of several aspects of Obamacare that has made the health law popular since its passage years ago.

The unchecked coronavirus pandemic has put health care and coverage issues front and center for Americans, who have seen a shambolic federal response contribute to Covid-19 infections soaring toward 5 million and deaths blasting above 160,000 (at a staggering rate of 1,000 deaths per day). 

With the virus clobbering the economy and 32.1 million Americans claiming unemployment benefits (as of July 18), record numbers of workers have lost their job-related health coverage and many have sought the safeguards available by securing new policies on ACA exchanges (with government support) or via Medicaid because their income has plunged to poverty levels.

The independent, nonpartisan Kaiser Family Foundation previously has estimated that 27 million Americans lost employer-sponsored health coverage as the coronavirus crushed the U.S. economy and caused skyrocketing unemployment. Foundation experts say that roughly half this group or 12 million people may find coverage via Medicaid, while 8.4 million will get subsidized policies on ACA exchanges, and others may afford the pricey benefits continuation under the so-called COBRA option.

With worries about keeping the roof over their heads and feeding themselves and their loved ones, the jaw-dropping number of suddenly jobless clearly may not be open to almost theological theorizing from political partisans (the GOP) as to why and how the federal government should have no role in the U.S. health care system, especially in helping people with insurance. A shaky economy and persistent unemployment, instead, may undercut a year’s worth of political bickering about Democratic ambitions to not only bolster the ACA but also push toward a single-payer system of some sort, much criticized plans of various sorts described in shorthand as “Medicare for all.”

For insurers, an ’embarrassment of profits’

Here’s another factor that will undercut GOP arguments about health insurance and the ACA, as reported by the New York Times:

“The nation’s leading health insurers are experiencing an embarrassment of profits. Some of the largest companies, including Anthem, Humana and UnitedHealth Group, are reporting second-quarter earnings that are double what they were a year ago. And while insurance profits are capped under the Affordable Care Act, with the requirement that consumers should benefit from such excesses in the form of rebates, no one should expect an immediate windfall …

“Although many hospitals have been overwhelmed by the coronavirus outbreaks raging from state to state, insurers have shelled out billions of dollars less in medical claims in the last three months because expensive, elective surgeries have been postponed in many places. Moreover, people have steered clear of doctors’ offices and emergency rooms in fear of contagion.

“The companies’ staggering pandemic profits stand in stark contrast to the scores of small medical practices and rural hospitals that are struggling to stay open. And the earnings are putting a spotlight on the big insurance companies at a time when government officials in many states are facing massive budget shortfalls as businesses collapse, unemployment rises, and tax revenues plummet. Some states are discussing cutting payments to insurers that offer Medicaid plans to their residents.”

Good golly. In my practice, I see not only the harms that patients suffer while seeking medical care, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, uncertainty, and complexity of therapies and prescription drugs, too many of which turn out to be dangerous drugs.

The Covid-19 pandemic has driven home for Americans how we all are way too vulnerable to sudden, major, and costly sickness or injury that not only can debilitate but bankrupt us. The U.S. health care system — on which this nation spends $3.7 trillion annually, while seeing some of the worst outcomes among western industrialized nations — needs many fixes, not the least of which is ensuring health insurance coverage for as many of us as is possible.

Obamacare is imperfect and needs fixes, as do Medicaid, Medicare, and Social Security. But these crucial parts of the nation’s social safety net are desperately needed, and, contrary to how critics deem them as “entitlement programs,” taxpayers contribute to and support them through their working lives in hopes they will assist them. Health care in the world’s wealthiest nation must be a right and not a privilege. Sharing the risks and costs of medical services helps to protect the many and avoids skewering the ill or injured few. A growing body of research shows that Obamacare has benefited Americans and their health.

Voters have over time embraced over time not only the ACA’s pre-existing condition protections but also how Obamacare: lets parents keep young people on their policies until age 26; and safeguards patients from insurers’ efforts to impose lifetime caps or limits on benefits, notably for common, chronic conditions like heart or lung disease, and cancer. All these protections might vaporize not only in policies on the ACA exchanges but also in employer-provided coverage if the GOP got its wish and Obamacare were repealed. Is this good for the country — for tens of millions of Americans to be vulnerable to economic ruin due to relentlessly increasing health care costs and an absence of coverage? Do Americans want to see profit-soaked insurers while the access and affordability of their care spirals out of reach?

That is not what voters are saying they want — at the ballot box. Let’s see if they exercise their constitutional rights and responsibilities and make their wishes known even more powerfully in November.