By Adam Pagnucco.

President-Elect Donald Trump and the new Republican-controlled Congress are proceeding rapidly to dismantle the Affordable Care Act (ACA).  The law, a complicated amalgam of policy and funding requirements, has helped 20 million Americans gain health care coverage and has cut uninsured rates dramatically across many racial and ethnic groups.  Its repeal threatens to throw millions of Americans out of health care coverage, including hundreds of thousands of Marylanders.  And so far, Governor Larry Hogan is standing by silently and letting it happen.

The ACA has expanded health insurance coverage in two primary ways: setting up government-run health care exchanges and expanding Medicaid, the federal/state health insurance program for low-income people.  In Maryland, 146,808 people are currently enrolled for coverage through the state’s exchange, Maryland Health Connection.  The latter entity reports that roughly 278,000 more people are covered by the ACA’s expansion of Medicaid.  All told, more than 420,000 Marylanders have obtained health coverage through the ACA and two more weeks remain in the enrollment period.

Marylanders in every county are enrolled in the state’s health exchange.

Under the ACA, the federal government has invested a lot of money in increasing enrollment.  Maryland Health Connection reports that Maryland health care exchange participants receive about $225 million in annual federal tax credits to subsidize their individual health insurance premiums.  The Kaiser Family Foundation estimates that the federal government spent $5.7 billion on Medicaid in Maryland in Fiscal Year 2015.  These funding sources are now at risk.

Since it is a federal law, some changes to the ACA must pass a 60-vote hurdle to overcome filibusters in the U.S. Senate, where the GOP has just 52 seats.  But budget items are not subject to filibusters.  That means part or all of the above federal funding to support ACA enrollment could be eliminated in a budget passed solely with Republican votes and signed by President Trump.  If that happens, millions of Americans and possibly hundreds of thousands of Marylanders could lose their health coverage.

That’s not all.  The federal tax credits and Medicaid funding under the ACA support lots of jobs and income in the health care industry, and through the multiplier effect, the broader economy as well.  A new study from George Washington University estimates that if the ACA’s tax credits and Medicaid funding are repealed, Maryland will lose 52,000 jobs by 2019.  The study projects that Maryland will also lose $49 billion in business output and $982 million in state and local tax revenues from 2019 to 2023.  All of this would be on top of any federal agency cuts that Trump and the Republican Congress might include in their next budget.

Any Governor would be expected to jump up and down about the prospect of losing tens of thousands of jobs and hundreds of millions in tax revenues as well as having hundreds of thousands of constituents lose health care coverage.  But not Larry Hogan.  He has stayed silent as Donald Trump and his Republican colleagues in Washington plan to destroy health care in Maryland.  Hogan bristles at questions from reporters about anything going on in Washington, telling one of them that he was tired of “stupid questions about the Trump administration.”  And yet, the Trump administration’s actions will have gigantic negative impacts on his state that he declines to oppose.

All of this begs the question.  Is Larry Hogan with Donald Trump and anti-health care zealots in the Republican Party?  Or is he with the rest of us?