By Ilana Novick / AlterNet

Remember death panels? It seems like only yesterday when rabid Tea Partiers tried to convince the public that under the Affordable Care Act, Grandma’s fate was in the hands of so-called death panels, a fictitious team of insurers and (probably devil-worshipping) Democrats who would determine the extent of coverage. Many of the most diehard proponents of this lie, who went on to benefit from the ACA, are about to meet the real death panelists—their names are Paul Ryan, Mitch McConnell, Tom Price, and Donald Trump, and according to two experts who have studied the impact of insurance coverage on death rates for 30 years, approximately 43,000 Americans are at risk of death if the ACA is repealed.

As researchers David Himmelstein and Steffie Woolhandler explain in the Washington Post, “The story is in the data: The biggest and most definitive study of what happens to death rates when Medicaid coverage is expanded, published in the New England Journal of Medicine, found that for every 455 people who gained coverage across several states, one life was saved per year. Applying that figure to even a conservative estimate of 20 million losing coverage in the event of an ACA repeal yields an estimate of 43,956 deaths annually.”

The bare outlines of Trump’s policy agenda promise to eliminate minimum standards for insurance coverage, the same standards that now prevent insurance companies from denying coverage to Americans with pre-existing conditions. This impacts even those currently unaffected by the law: “Abolishing minimum coverage standards for insurance policies would leave insurers and employers free to cut coverage for preventive and reproduction-related care. Allowing interstate insurance sales probably would cause a race to the bottom, with skimpy plans that emanate from lightly regulated states becoming the norm.”

During the campaign, Trump promised to protect Medicare and Medicaid. That was great for rallies, but in 2017 there are also threats to block grant Medicaid, which would leave countless poor Americans at the mercy of state governments which, the researchers remind us, “have shown little concern for the health of the poor.”

Medicare wouldn’t fare much better:

A Medicare voucher program (with the value of the voucher tied to overall inflation rather than more rapid medical inflation) would worsen the coverage of millions of seniors, a problem that would be exacerbated by the proposed ban on full coverage under Medicare supplement policies. In other words, even if Republicans replace the ACA, the plans they’ve put on the table would have devastating consequences.

Senate Minority Leader Chuck Schumer wasn’t kidding when he called the Trump administration’s health care plan “a war on seniors.” It’s also a war on the poor, the sick and frankly, all Americans who aren’t billionaire members of Trump’s cabinet. We can’t take comfort in the uncertainty of what the second half of “repeal and replace” means.

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