The Affordable Care Act (ACA) is the zombiest health-care program in the country. No matter how long or hard Republicans have tried to kill it, it just keeps humming along.

Republicans’ obsessive, 15-year hatred of the ACA, aka Obamacare, is not hard to understand.

First, it was created by Democrats and signed into law by their arch nemesis, Barack Obama.

Second, it smacked of dreaded socialized medicine, ignoring the fact that America’s highly successful government-managed programs, Medicare and Medicaid, have been around for more than 60 years.

It is also not hard to understand why Republicans can’t kill Obamacare, even when they control the government: 45 million lower-income Americans depend on the ACA for their health insurance, with federal government subsidies making it affordable. Added to that, 64 percent of Americans hold a favorable view of the ACA, according to a KFF health-tracking poll.

In addition, Republican-controlled states have among the highest rates of ACA participation. Since the program was enacted, more than half of the national growth in ACA participants has come from Texas, Florida, Georgia, and North Carolina.

In Texas, Louisiana, Mississippi, Tennessee, Georgia, and West Virginia, enrollment has more than tripled in the last five years. The popularity of ACA, its tremendous success in providing health care for 45 million Americans who couldn’t otherwise afford it, and the fact that a large portion of ACA participants reside in Republican-controlled states make Republican politicians extremely leery of messing with Obamacare. Even Marjorie Taylor Greene’s support for extending ACA subsidies to help her constituents didn’t cause a massive MAGA earthquake.

Since ACA subsidies were not approved as part of the deal to reopen the government, Republicans have had another opportunity to huff and puff over that horrible Obamacare before they inevitably approve the subsidies as they have done annually for more than a decade. With the most consequential mid-term election in modern history looming in 2026, they will do as little as possible to upset millions of their constituents who depend on Obamacare.

Naturally, President Trump inserted himself into the health-care discussion. Trump proposes that the subsidy money being sent to the “money sucking insurance companies” be sent instead to ACA participants so they can get “much better” insurance on their own. So instead of the government providing subsidies directly to the health-care providers to make the insurance plans affordable for lower-income Americans, the participants themselves would provide the money to the “money sucking insurance companies” to purchase their health insurance.

Am I missing something?

First, the “much better” insurance outside the ACA doesn’t exist. The same major companies provide health insurance both inside and outside ACA, including Kaiser Permanente, Aetna, Blue Cross Blue Shield, Cigna, and Anthem. In addition, under ACA, no participant can be denied coverage due to a preexisting condition, all plans must include essential benefits including prescription drugs, maternity care, and behavioral benefits, and insurers are banned from setting annual or lifetime limits on benefits.

Second, since the subsidies pay for a set percentage of the cost of the insurance plan, the amount of the subsidies rises annually with any premium increases. If money is paid directly to participants, it can be eaten up quickly if an annual inflator isn’t provided. In addition, there is no guarantee that such payments would exist from year to year, as have the ACA subsidies.

Cash payments are a bad idea that would ultimately make health insurance less affordable for lower-income Americans. Like most unsound, half-baked ideas for which Mr. Bleach Injection is famous, it was first spread in capital letters on the Truth Social propaganda platform complete with the customary misinformation.

As to those money-sucking for-profit insurance companies, they are the companies who Trump and Republicans have supported at least since Republican president Dwight Eisenhower campaigned against “socialized medicine” in 1954. They have been the Republican bulwark against the socialized healthcare programs common among advanced democracies in Europe and Asia as well as Canada and Australia.

Unfortunately, the long-standing Republican belief that America’s free-market competition would keep health care affordable is a myth. The major insurance companies form a virtual oligopoly that controls prices and supply. The for-profit health insurance industry does what every successful capitalist industry does: maximizes profits. For our grifter president to rail against these “money-sucking” insurance companies is knee-slapping hypocrisy.

The ACA was always intended to be a bridge program between the traditional for-profit health-care system and a future universal health-care system which the majority of Americans support. The ACA is far from perfect since it still utilizes for-profit companies to provide the health insurance, but for 45 million Americans, it’s the best we’ve got for now.

For decades Republicans haven’t come up with a workable plan to reduce health-care costs. They are tied to the for-profit health-care system where solutions simply don’t exist. Attacking Obamacare has been all they have had in their arsenal, which does absolutely nothing to fix America’s broken health-care system.

Medicare has proven a much less expensive health-care system than the private insurer system since it doesn’t exist to make money and has the power and leverage to pay considerably less for hospital and physician services than private insurers.

Expanding government-managed Medicare to all Americans would reduce health-care costs, remove for-profit insurers from the system, and guarantee coverage for all Americans like citizens in every other advanced democracy. The next step could be offering a government health-care option like Medicare alongside traditional for-profit insurance programs for Americans to choose between.

In the past, Republicans have complained that offering the government-sponsored option would eventually kill off the for-profit insurance companies since it operated at an unfair advantage and would be cheaper. Advantage the American people.

  • Tom Tyner is a freelance editorialist, satirist, political analyst, blogger, author and retired English instructor.