So demands that the A.C.A. be scrapped always meant taking away coverage from the people who need it most; Obamacare opponents just hoped people wouldn’t notice that fact. And the truth is that they mostly got away with it until last year, when Republicans had to offer specific health care legislation.
At that point the game was up. It immediately became clear that every Republican alternative to Obamacare would, in fact, hang Americans with pre-existing conditions out to dry. And the public backlash against that revelation is basically the reason the G.O.P.’s repeal effort failed. But it only failed narrowly. And if Republicans still hold Congress next year, anyone who has a history of medical problems and doesn’t get health insurance from his or her employer will lose coverage.
In fact, even getting a job with insurance coverage might not be enough: If the Trump-supported lawsuit succeeds, employers could refuse to cover new employees’ pre-existing conditions.
What may seem puzzling about all this is the cruelty. O.K., Donald Trump is obviously a man utterly lacking in empathy. But don’t other Republicans feel a bit bad about the prospect of taking health care away from millions of Americans who have done nothing wrong besides having past medical problems?
Actually, no. Consider Rick Scott, the governor of Florida (and current Senate candidate), whose attorney general has joined the lawsuit to eliminate protection for pre-existing conditions. While refusing to say whether he supports the suit, Scott declared, “We’ve got to reward people for caring for themselves.” Right, because if you get cancer, or arthritis, or multiple sclerosis — all among the pre-existing conditions for which people used to be denied coverage — it must be your own fault.
By the way, a note to older Florida voters: You may think that none of this matters to you, because you’re covered by Medicare. If so, think again: If Republicans win in November, they’ll be coming after Medicare next, to offset the cost of their tax cut. Who says so? They do.
So, as I said, voters need to understand the stakes in these midterms. They will determine whether people with medical problems get the health care they need.