The same guys who say we're morally obliged to use fossil fuels are now claiming Trump isn't sabotaging the ACA.

David Balat is the director of the Right on Healthcare initiative at the Texas Public Policy Foundation, a conservative think tank which pushes school vouchers and which attempts--against all sanity--to claim there's a moral case in favor of fossil fuels, which I guess should be described as "natural gaslighting."

Anyway, the other day, Mr. Balat posted an op-ed at The Hill in which he tries to gaslight America regarding the lengthy list of ACA sabotage efforts which have been (and which continue to be) pushed by the Trump Administration, some more successfully than others.

Repeated claims of sabotage of the ACA by the Trump Administration fall flat because of these important initiatives put in place by the president. Although the president has chosen to not defend the ACA in the Texas v. Azar case, he has made numerous strides to make available options to help Americans who require coverage suited to their needs, as well as help for those with chronic conditions.

First of all, it's the Department of Justice's job to defend against lawsuits brought against it over the standing law of the this case, the Affordable Care Act. Secondly, the DoJ didn't just "choose not to defend" the ACA against the lawsuit, they're actively siding with the plaintiffs in calling for the entire law to be struck down.

Balat spends most of his op-end trying to change the subject. First, he talks about the opioid additiction crisis:

Recently, the Centers for Disease control and Prevention (CDC) released a report demonstrating that the work of the administration's opioid commission is producing results. Preliminary data shows that reported drug overdoses declined in 2018 by 4.2 percent. This is the first-time overdoses have gone down, year-to-year, since the crisis began. Although some states showed an increase in deaths related to overdose, overall national numbers are moving in the right direction.

Donald Trump loves to try and take credit for work done by other people, and he loves to jump on favorable statistics (or simply make them up out of whole cloth) when it suits him while ignoring them when they don't. In the case of the opioid commission, his boasting is, to put it mildly, premature:

...But behind the scenes, his administration’s efforts to address the opioid crisis are increasingly contentious. Two federal agencies are feuding over how to classify certain drugs too dangerous for public consumption. And in the two-plus years since his inauguration, his White House has yet to nominate a leader for the Drug Enforcement Administration.

Public health experts caution that not only is Trump claiming victory too early — his sometimes-chaotic approach might actually be setting back public health efforts to rein in a broader drug crisis that currently claims 70,000 lives per year.

Furthermore, guess what?

Because of the ACA, an estimated 26 million people have health coverage through the marketplaces or Medicaid that includes substance use disorder (SUD) treatment and prevention. Additional people enrolled in new individual market or small group market plans outside the marketplace also now have SUD treatment covered because most individual and small employer insurance plans can no longer exclude SUD treatment. And, as Ohio Governor John Kasich recently noted, the Medicaid expansion is getting SUD treatment services to people in need.

In addition, coverage expansions under the ACA help people afford regular access to care, including mental health services and treatment of underlying conditions that can help to prevent SUD or allow for early identification and treatment. However, a repeal of the ACA would more than double the uninsured rate and, in the three states with the highest drug overdose deaths—Kentucky, New Hampshire, and West Virginia—a repeal would about triple the uninsured rate. Repealing the ACA will remove coverage for SUD treatment and prevention from millions of Americans, leaving a gap in care when it is most needed.

Balat then tries to make it sound as if Trump is on the verge of curing HIV and AIDS...

According to the Department of Health and Human Services, "President Trump announced one of the most important public health initiatives in history: ending the HIV epidemic in America."

...Except his record on the issue is spotty at best...

Although public health researchers and advocates have been largely welcoming of the initiative, some have said that the administration has an uneven track record on HIV policy. Trump, for example, went a year after firing his HIV/AIDS advisory panel before new members were sworn in, and the administration has also turned back health protections for LGBT Americans.

Furthermore, guess what?

Medicaid is the single largest source of coverage for people with HIV in the U.S. and its role for those with HIV has significantly expanded under the ACA. Indeed, the Medicaid expansion provision is arguably the aspect of the law that has had the most far reaching effects on people with HIV, driving a nationwide increase in access to insurance. Proposals that have been put forward, including the amended AHCA which has now passed the House, have sought to change both the Medicaid expansion and the traditional Medicaid program.

...Prior to the ACA, it was nearly impossible for people with HIV to access private coverage through the individual market. In most states, issuers were permitted to take health status and history into account when deciding whether to issue an individual policy, including under what terms, and in determining premium cost. Most with HIV were considered “uninsurable” and either denied individual market coverage outright or, when offered, rates were typically unaffordable and/or policies included sweeping exclusions. Under the ACA, individuals are guaranteed access to health insurance through the individual market regardless of health, rates cannot be set based on health status, and lifetime and annual limits are prohibited.

Next, Balat continues to avoid discussing the ACA itself by pivoting to kidney disease:

The costs associated with kidney disease and transplantation can be extraordinary. Furthermore, the medication that is needed to sustain the transplant can be very expensive. According to a press release from the Centers for Medicare and Medicaid Services, "The proposed ETC Model would include protections for both beneficiaries and participating ESRD facilities and Managing Clinicians." The goal through this effort is to reduce the number of Americans with end-stage renal disease by 25 percent by the year 2030.

Sounds great! Except for one tiny problem:

This last point leads me to raise a significant cautionary note for law and policy makers. The Affordable Care Act currently makes it illegal for health insurance companies to deny coverage or increase costs for pre-existing conditions, including kidney donation. This was not always the case: In the past, kidney donors could be (and were) denied coverage for just this reason.

If the Trump administration succeeds in its ongoing efforts to strike down the ACA, a signature pledge of his campaign, millions of Americans could be left uninsured, current and potential living donors could again become legitimately fearful of being uninsurable at reasonable cost, and other innovative efforts to improve kidney care could also be at risk.

Millions of Americans could benefit from President Trump’s “sweeping set of proposals” on kidney care — I hope he, Congress, and the courts do not undermine those significant improvements by sweeping away the protections provided by the ACA.

Balat finally moves to the ACA in the last few paragraphs:

The millions of very poor and elderly in this country have a safety net for their medical care. Not so for the middle class, which has been harmed most by the increase in premiums and deductibles in recent years....

The Affordable Care Act was meant to help people get coverage, but the unintended consequence (as is often the case with government over-reach) was that it made health care unaffordable. Deductibles have more than tripled, and - according to a recent poll by KFF and the LA Times - these deductibles are what most middle class Americans are angry about....

Yes, it's true that premiums and deductibles for middle-class (unsubsidized) ACA enrollees have increased significantly over the years. I'm the one who's been tracking those increases since 2015, after all. In 2018, average unsubsidized premiums for ACA-compliant plans did indeed increase by around 28% on average...most of which was due specifically to Trump's decision to cut off Cost Sharing Reduction subsidy reimbursement payments. You know, the very subsidy program which reduces deductibles and co-pays for lower-income ACA enrollees.

Some continue to claim that the ACA increase in premiums is due to some sort of sabotage, but a study by KFF has shown otherwise. The study clearly states that, "premiums in much of the country are holding flat or decreasing a bit... On the exchange, meanwhile, subsidized customers will continue to pay sliding-scale premiums based largely on their incomes, and so the amount of premium they pay is mostly unaffected by the repeal of the individual mandate and expansion of short-term plans."

As for 2019, it's true that premiums only went up around 2.8% on average this year, and in many states they held steady or dropped...but they would have gone down by around 5.4% on average nationally if not for Congressional Republicans and Trump zeroing out the ACA's individual mandate penalty.

That means those very middle-class enrollees Balat is sympathizing with are currently paying roughly $580 more apiece each year than they otherwise would be if the mandate penalty hadn't been set to $0.

Oh, and that reminds me: The GOP zeroing out of the mandate penalty is itself the very thing which allowed for 20 Republican Attorneys General to file the Texas vs. Azar lawsuit...the lawsuit which threatens to strike down the entire law in the first place.

Moral arguments, my ass.