During the presidential election campaign, candidate Donald Trump called the Affordable Care Act a disaster and said, if elected, he would immediately replace it with a new and better system.
Trump’s vow echoed Congressional Republicans, who over the past six years voted more than 60 times to repeal the Affordable Care Act.
Then the election was held and candidate Trump became President Trump with both houses of Congress in Republican control.
Since then, Trump and Congressional Republicans have acted like the dog that caught the bus it was chasing.
Republicans discussed repeal and delay, Trump discussed repeal and replace but in the face of as many 22 million Americans losing their health insurance nothing has been done.
Turns out, despite all the rhetoric and all the votes, Trump and the Republicans had no plan they could agree on to replace the Affordable Care Act.
In an interview with Bill O’Reilly of Fox News on Sunday, Trump gave his latest estimate of when he and Congressional Republicans would have a plan, saying “Yes, I would like to say by the end of the year, at least, the rudiments, but we should have something within the year, and the following year.”
Which is not to say that nothing will ever happen on health care or a number of issues with a profound effect on the lives of New Yorkers ranging from immigration to abortion to the environment over the next four years.
In fact, the odds are more than good that some if not all these changes will take place at some point during this period.
All of which will make the decisions of governors and state legislatures across the country that much more important.
And, yes, for New Yorkers that means the New York State Legislature.
Like it or not, decisions that have been determined at the federal level may now be determined by members of that Legislature as well as Gov. Andrew Cuomo
For instance, there is a reasonable likelihood that Roe v. Wade, the landmark decision in 1973 by the United States Supreme Court that a right to privacy under the Due Process Clause of the 14th Amendment extended to a woman’s decision to have an abortion, will be overturned.
In that case, the issue of abortion will return to the states.
New York State had legalized abortion before Roe v. Wade but with more restrictions than federal law.
Will a more restrictive abortion law stand in New York, or will the law be amended to mirror the rights under Roe v. Wade?
On Monday, the Assembly passed a package of proposals to expand protections to immigrants that would, in the words of one legislator, make New York a “sanctuary state.” That would bring the state in line with New York City, which since the administration of Mayor Ed Koch has had a policy of not arresting or reporting undocumented immigrants to the federal government for non-serious crimes. City and police officials say his policy has aided law enforcement by making undocumented immigrants willing to report crimes and cooperate with police investigations.
Republicans have called the package a threat to law enforcement statewide and President Trump has said he would restrict federal funding from cities that do not comply with federal immigration policy.
The greatest stakes could be in health care.
Cuomo recently said that if the Affordable Care Act was repealed with no replacement an estimated 2.7 million New Yorkers would lose coverage and New York State would experience a direct state budget impact of $3.7 billion and a loss of nearly $600 million of federal funding that goes directly to counties. In Nassau County, the governor estimated that 133,324 people would be at risk of losing their coverage and $17.8 million in Medicaid funding.
No one — including Trump and Congressional Republicans — can answer at this point what if anything will happen to the Affordable Care Act or what might take its place.
But if the Affordable Care Act is repealed and not replaced New York would have options.
One of them would be to follow the State of Massachusetts.
Before there was an Affordable Care Act, known to most as Obamacare, there was Romneycare, a health care plan very similar to the Affordable Care Act enacted by a Democratic legislature under a Republican governor — Mitt Romney.
Both plans closely following a proposal put forward in the mid 1990s by conservatives in response to Hillary Clinton’s failed proposal for universal health insurance during her husband’s administration.
These are all possibilities.
What we can count on is the importance of the governor and the state Legislature in guiding the state’s future in the next four years.
This makes the choice of who we elect to the state Legislature that much more important.
