The Grand Old Party may have just won the dictionary definition of a Pyrrhic Victory. That’s because Republicans’ decade-long assault on the Affordable Care Act his finally showing predictable results, with the share of Americans lacking health insurance increasing for the first time in 10 years.

The rate and number of people without health insurance increased from 7.9%, or 25.6 million, in 2017 to 8.5%, or 27.5 million, in 2018, officials reported.

The nation’s children got a kick in the face, too, with almost half a million more youngsters uninsured in 2018 versus 2017 — a decline attributable mostly to a reduction in the number of kids covered by safety net programs like Medicaid and the Children’s Health Insurance Program aka CHIP.

Data on national health coverage came from the U.S. Census Bureau and defied trends experts typically record. Health coverage usually increases when the economy is holding in generally good stead, as it is now. Flusher times meant that fewer Americans live in poverty, and poorer workers showed some of the best wage gains, the Census Bureau found.

But this positive news was offset by troubling trends including:

• Poorer Americans struggling to get health coverage, especially at their workplaces. Most Americans get job-linked health insurance. But as low- and lower-paid employees have gotten work in a stronger economy, they haven’t shared in the usual workplace benefit of health coverage.
• The uninsured rate, as the Washington Post reported, “spiked especially among adults who are Hispanic and foreign-born. Coverage also dwindled among children who are Hispanic and naturalized citizens.” Critics say these coverage declines may be blamed on the Trump Administration’s harsh language and actions on immigrants and immigration, legal and otherwise.
• The poor and working poor saw their health coverage go down due to usage declines with Medicaid. States, with Trump Administration encouragement and approval, have sought to tighten eligibility for key safety net programs, while also imposing Draconian work rules and other reporting requirements that add to recipients’ “red tape” burdens.

Experts expressed concern at the first-in-a-decade health coverage declines, noting they spell worry for Americans’ medical troubles if the slowing economy worsens. Eliot Fishman, a senior director at the consumer group Families USA and a ranking Medicaid official in the Obama administration, told the New York Times: “It’s very frightening in that, if this [decline] is happening now with unemployment at 3.7%, then what’s going to happen when the employer coverage situation gets worse. There’s a fear we could see really dramatic increases in the uninsured rate if that happens.”

The newspaper said critics point to key Republican and Trump administration actions to attack the ACA that also reduced Americans health coverage:

 “The administration cut back on advertising and enrollment assistance, programs that helped low-income people learn about the new insurance programs, among other changes that may have depressed the number of people signing up for health plans. The government also announced that it might begin counting Medicaid enrollment as a strike against immigrants who are seeking green cards or citizenship — a policy that became final this year. Insurance coverage for Americans of Hispanic origin fell last year … The administration’s decision in 2017 to eliminate a subsidy program contributed to large price increases for health insurance in the Obamacare marketplaces in many parts of the country the next year. Research from the Department of Health and Human Services shows that more than a million Americans who were previously buying their own insurance left the market in 2018.”

Health care experts expressed concern about the declines in children’s health coverage. Joan Alker, executive director of the Georgetown University Center for Children and Families, which has tracked the enrollment decline for the main health care safety net programs for children, told NPR:

“It’s a very smart investment to make sure that kids get Medicaid when they need it. And that’s exactly the opposite of what’s happening today … The data [from] the Census Bureau confirmed our worst fears. We know from a lot of research that children who have Medicaid as opposed to those who are uninsured are more likely to succeed in school and more likely to graduate from college. They also have better health as adults and higher earnings, which means they’re less likely to rely on government assistance as adults.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which prove to be dangerous drugs.

Insurance coverage has become a central focus of the national conversation about health care. It isn’t the only issue that officials can and should address. It is a fundamental, however, a vital way that Americans can deal with skyrocketing medical costs and medical debt that all too often leads in unacceptable fashion to medical bankruptcy. We’re all just one major injury or illness away from financial and personal calamity, and health insurance provides a way that we collectively can share the risks and costs of health care — which should be a right not a privilege in this country.

Unfortunately, the GOP has adopted a near theology that government should play as little or no role in helping the poor, working poor, and middle class deal with the heavy burdens of health care, which takes up almost 18% of the nation’s GDP and accounts for $3.5 trillion in total expenditures.

Obamacare was and is imperfect, and it needs fixing — but not the long running GOP campaign to repeal the ACA without providing a concrete, workable, and useful replacement. Voters in the midterm election, turning over 40 seats in the U.S. House, demonstrated their displeasure with the Republicans’ relentless assault on Obamacare. It included eliminating its mandate and penalties for Americans who forego health coverage, and, instead, offering more than $1 trillion in tax breaks to wealthy corporations and the richest Americans.

The Trump Administration since has offered not only recycled and failed coverage options — such as skimpy plans that cost less but fail to provide patients important protections for preexisting conditions and then pay out nothing when they’re most needed for injury or illness — officials have taken to courts to make dubious legal attacks on the ACA.

As the Washington Post reported, this may become the petard on which partisans will hoist, as administration officials — but not the president, of course — are scrapping plans to try to put out Trump’s long-promised but never delivered comprehensive health plan to supplant the ACA. Instead, officials are in panic mode to figure what the response will be if, as many expect, a GOP-leaning appellate court accepts arguments by the U.S. Justice Department and Republican attorneys general and strikes down the entire ACA, as an extreme federal judge in Texas already has tried to do. What happens if the U.S. Supreme Court takes up an ACA-killing appeal and rules just before the 2020 election?

That action, experts say, could destabilize not just ACA health insurance exchanges but also create big uncertainty in employer-provided coverage, the chief source for health insurance for most Americans. The appellate ruling is expected soon and would be political dynamite for Republicans, especially because they have failed in their decade of Obamacare opposition to develop or implement anything equal or better. Though the Democratic presidential candidates have, thus far, marched through a thicket of policy wonkiness about ideal and elusive universal coverage plans, the opposition party — already strong on the issue — could see significant electoral gains in 2020 if the public sees further erosion on the quality and cost of health care. It has become a top issue for the upcoming presidential elections, polls show.

The upcoming vote will be critical, indeed, for Americans, and we need to keep a close and skeptical eye on every health care development in the days ahead and act on our informed views.