As we prepare to watch the next debate of the Democratic presidential candidates, it is likely that we will see more back and forth about the type of comprehensive health care coverage that should be put in place. Options on the table include Medicare-for-all; Medicare-for-all who want it; and the restoration and strengthening of some of the key features of the Affordable Care Act (ACA), aka, Obamacare.

What has attracted hardly any attention on the debate stages or on the stump so far is something that is of more immediate concern. The Republican Party through the actions of their state attorneys general; through the Trump administration’s aggressive position against Obamacare; and through the actions of the party’s representatives in Congress has been laser focused on taking away coverage from millions of Americans and wiping out popular and important features of the ACA such as protections for those with pre-existing conditions and coverage up to the age of 26 under family plans for children who do not have an insurance plan of their own.

Donald Trump, having promised in 2016 “we going to have insurance coverage for everybody,” has failed miserably. He and his supporters in Congress did their best to kill Obamacare, but they failed because of the courage of John McCain. They failed after seven years of bragging about their plans to come up with an alternative to the ACA. Trump also promised action last year, and now he says it is coming after the 2020 election. I hesitate to quote a convicted felon, but as Richard Nixon’s Attorney General and campaign manager John Mitchell famously said, “watch what we do, not what we say.”

The issue at hand concerns a law suit (Texas v. Azar) initiated by twenty Republican state attorneys general and governors to totally strike down Obamacare. The Trump administration has told the federal court that they support that action. We are likely to see a decision from the Fifth Circuit Court of Appeals in the very near future.

It is not as if the Trump administration has not already done great harm to the ACA. Through the issuance of regulations they have chipped away at the coverages and protections that existed in the law.

One of the most significant actions concerns expanding the role of short-term health insurance policies that are sold as low cost options for people anxious to have some sort of coverage in place for themselves and their families.

The ACA provides for the sale of short-term health insurance policies as a bridge for people who lack insurance and are not yet eligible for coverage under the ACA. Insuranceopedia defines short-term insurance as follows: “[A] Short term policy is an insurance for those who do have access to or are not yet eligible for policies that cover a lengthier period or for coverage that is comprehensive. The period covered for this policy is one month to six months. Compared to regular insurance, the benefits are limited.”

The Trump administration, however, has now transformed these plans into a long-term alternative to more legitimate and protective plans. It has now permitted short-term plans to extend for a year or more, even when offering just minimal coverage for those who purchase them. You might characterize such plans as “fake insurance.”

Unfortunately such plans seem to move in sync with a broader re-design of health insurance. Limited insurance plans may have a devastating effect on the public.

For those of us who have been in the workforce for many, many years, we have or have had the luxury of insurance plans with low co-pays for our medical providers, as well as generous low cost prescription drug plans. Up until relatively recently, deductibles were either non-existent or relatively minor. We often just paid our inexpensive co-pays without any thought for what insurance costs or what it actually pays for.

At the root of the high cost, low coverage of many insurance plans, of course, are the high costs of all elements of health care. I would recommend for anyone who is seriously interested in understanding the full picture of medical expenses to pick up a copy of “An American Sickness” by Elisabeth Rosenthal. The book systematically analyzes all aspects of health care and details how the costs of medical coverage have grown out of proportion to value or normal cost escalations.

It is not as if all of our expensive health care insurance and available medical help has led to substantial positive results across a wide spectrum of Americans. The average life expectancy in this country has gone down each of the last three years. The crisis relating to drug over-use is cited as a one of the major reasons for the decline.

The impeachment inquiry is an incredibly important matter for the future of this country, but as we move toward the 2020 elections we should all hope that other matters critical to the country’s future are given rightful attention in the debates about where this country is going.

All the Democrats in the presidential primary and undoubtedly in the 2020 congressional campaigns support universal health insurance coverage in this country. The same cannot be said of the Republicans.

The Republican Party has actively fought to take away health insurance coverage from millions and to make what is left more costly and less protective. No detailed alternative plans have been offered. The party’s candidates must be called out on these matters.

So what say yee, Chris Jacobs, Robert Ortt, Beth Parlato, Stefan Mychajliw, and David Bellavia? Do you stand with improving health insurance coverage or taking it away? How will you pay for whatever you propose?

If the Republicans are successful in taking away medical insurance coverage and in removing the patient protections that the ACA provides, it seems likely that the reduced availability of coverage will impact hospitals that will in turn see increases in the cost of serving patients who are not able to pay for the services. The Erie County Medical Center in particular would be negatively affected.

Republican attempts to cut the medical insurance coverage will therefore, in some degree, fall on the table of county officials. So to that list of so far silent Republicans, add Republican County Executive candidate Lynne Dixon. Please tell us, Lynne, do you stand with those state attorneys general and Donald Trump in looking to take away ACA coverage? Inquiring minds want to know.