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Spokane, Washington  Est. May 19, 1883

Froma Harrop: May you be healthy and covered in 2019

A federal judge in Texas just threw out the Affordable Care Act root and branch. If the decision were to survive legal challenges, an estimated 17 million Americans could lose their health coverage. Uncounted others would face monstrous premium hikes as protections for pre-existing conditions vanish.

Upheld, the ruling would rocket Republicans toward their goal of killing Obamacare. President Trump didn’t hold back his joy, hailing it as “a big, big victory” by a “highly, highly respected” judge.

The downside for Republicans is that the program has become quite popular. That’s why they didn’t actually repeal it though they could have. Instead, they tried to dismantle it, screw by screw, in the dark of night.

Republicans had two years to replace or fix the ACA to their liking. They didn’t do it.

Trump said that if the judge’s ruling stands, “we will get great, great health care for our people.” Right, like Mexico will pay for that big, beautiful wall.

Time would be better spent discussing what Democrats should do, now that they will soon command a House majority.

What they shouldn’t do is push a radical makeover of the health care system in one swoop. A massive Medicare-for-all initiative would burden an already exhausted public with more disruption. Even a good number of Democratic House members oppose that approach.

Half of Americans – 160 million people – get their health coverage through their employer. Many may have complaints about rising premiums and out-of-pocket payments, but the great majority say they’re quite content with their health care. They might be better off in Medicare, but they don’t know that yet.

Better to start small. Start by letting Americans just below the Medicare eligibility age of 65 buy into the program – say, those 55 and up. The concept, “Medicare for more,” has been around for a while.

What would this do?

First off, it would help the group stuck with the highest premiums in the ACA insurance marketplaces. In most states, premiums rise with the subscriber’s age. Older Americans are charged more because they tend to use more health care. A Medicare buy-in would be especially helpful to those who earn too much to qualify for subsidies and currently face high premiums and deductibles.

Secondly, “Medicare for more” would be voluntary. There would be no coercion. People who qualify could take the deal or not.

Thirdly, it would be a step toward “Medicare for all.” It would demonstrate what happens when Medicare starts covering people who are still working. Seeing that the roof doesn’t crash down, the public might be more open to lowering the buy-in age further.

In the meantime, Democrats must fight in the courts and in the corridors of Congress to defend the ACA that we have. And they should redouble efforts to lower the outrageous cost of drugs. With Trump’s power to intimidate waning, some Republicans might work with them.

So much is at stake. In addition to the losses listed at top, the demise of the ACA would end guaranteed maternity care. Treatment for addictions, gone. Importantly for Americans of modest means, the dignity of going to the doctor through the front door would be taken away.

Americans have seen the Promised Land of health care security, and one can’t expect them to be shuttled back to the desert quietly. They spoke loudly in the recent midterms. If Republicans could lose 40 House seats in good part because of their threats to take away ACA benefits, imagine the results in 2020 if they actually did.

What happens to health coverage in 2019 will be a big, big deal for everyone. May you keep yours.

Follow Froma Harrop on Twitter @FromaHarrop.