How much do the healthiest people in society owe to the most vulnerable?
That question—about Americans’ capacity for shared sacrifice—was at the core of the struggle over repealing the Affordable Care Act during the first months of Donald Trump’s presidency. Now, it’s resurfacing in the escalating partisan debate over responding to the coronavirus crisis.
In designing the ACA, then-President Barack Obama and congressional Democrats put a premium on policies that encouraged more sharing of medical and financial risk among those with greater and fewer health needs, such as requiring insurers to guarantee coverage to consumers with preexisting conditions. During the repeal fight in 2017, Trump and congressional Republicans condemned those same efforts, arguing that the law required the young and healthy to sacrifice too much to reduce the risk to the old and sick.
A similar divergence is emerging as the country grapples with the social and economic strain of containing the rapidly intensifying outbreak. In his public comments this week, Trump—amplifying a chorus of conservative economists, elected officials, and media figures—has effectively argued that shutting down the economy is imposing financial pain on more people than can be justified by the number of lives the restrictions will save. Democratic governors, such as New York’s Andrew Cuomo, counter that the broader society has an obligation to save as many of the most vulnerable as it can, whatever the pain to the many. “Job one has to be to save lives,” Cuomo declared in a video he released Tuesday. “We are going to fight every way we can to save every life that we can.”