Thanks to Trump, a dark fate awaits us — but it can be a GOP electoral death knell too

You know how you’ve been listening to all the chatter about the expiring of the Affordable Care Act premium subsidies on Dec. 31 with about 25 percent of your attention? Well, it may be time to engage the other 75 percent.

Brace yourself, because this thing really is about to happen, devastating a giant swath of Americans.

It isn’t just some amorphous issue afflicting the lower class. No, ladies and gentlemen, it’s about to hit home for you too. The result of this expiration isn’t going to be abstract, gradual, or theoretical. It will instead be immediate, personal, and devastating for the millions who will be losing their health insurance almost overnight and millions more whose premiums will skyrocket.

That last part is where you probably come in.

See, premiums are going to rise for a huge swath of the country, not just subsidy recipients. It’s a death spiral effect. Healthier people drop their coverage first. Sicker people remain enrolled. Insurers raise their premiums to cover the higher average costs. More people drop coverage. The cycle repeats.

Working-class families will be hit hardest and most immediately. But not far behind will be older adults not yet eligible for Medicare including early retirees, self-employed and gig workers, and people with chronic conditions.

This has happened before. When subsidies shrink, enrollment drops fast, and the financial burden falls to those who stay in out of necessity.

Thank you so much, gutless and heartless Republican Party.

I’m pretty certain this is the one issue that’s finally going to screw these people – and by these people, I mean those who so gleefully and callously chose tax cuts for those who needed it least at the expense of the other 99.99 percent.

Sometime around about the second week of January, those premiums will be starting to double or triple, and folks o’er the land will be screaming about their president, “But I trusted him! Who could ever have imagined that a man who never showed an ounce of legitimate concern for people like me would screw me?”

What’s about to go down hasn’t happened at all by accident. It’s a deliberate act of sabotage. There’s no mystery. No surprise. No honest debate about tradeoffs. It’s just a rug being pulled without a thing supplied to replace it.

Oh wait, that’s right. They’ve proposed steering big cash money into something called health savings accounts — up to a couple thousand dollars! This is a bit like tossing someone a shirt, a pair of pants, a pair of shoes, and a quarter and saying, “There. That ought to be plenty to tide you over for the next year or two.”

It’s not just a joke; it’s an insult. And it’s criminal.

As with everything Donald Trump claims, he’ll say everything is fine with health care and it’s merely the radical left scum who are making a big deal out of this medical insurance thing. All they care about is making him look bad.

See, the enhanced ACA subsidies did something Republicans spent a decade claiming was impossible: they made the marketplaces work. Enrollment hit record highs. Premiums became manageable. Middle-class families who earned too much for help under the original law were finally protected from being bankrupted by insurance costs that bore no relationship to income.

Ending those subsidies rips apart that stability almost overnight. Faced with insane bills, people won’t “shop smarter.” They’ll do what millions have always done when health insurance becomes unaffordable. They’ll simply go without and pray they stay healthy.

Except, that isn’t how life and the human body work. Illness doesn’t care whether you’re covered or not. People still get sick. They still show up at ERs. They just can’t pay.

The systemwide consequences will prove catastrophic. Hospitals shift costs to insured patients. Employer-based insurance premiums rise. Safety-net hospitals face closure. State and local governments absorb the costs. This doesn’t save anyone money — it merely shifts the costs to those who can afford it least.

Medical debt spikes. Bankruptcies rise. Credit scores tumble. Health care becomes the leading cause of financial shock. It disproportionately devastates families earning $30,000 to $75,000, older adults, and people living paycheck to paycheck – in other words, those who can least afford it.

Preventable deaths will become unpreventable. When people stay away from doctors because they can’t afford them, there is far less early cancer detection. Diabetes and heart disease go unmanaged. Care is delayed. Conditions worsen.

Under the ACA expansion, there have been measurable reductions in mortality. But it doesn’t seem as if this concerns Republicans, who believe anything that helps the populace without political prejudice equates to socialistic evil.

You’ve already heard ad infinitum about how those in red states who support President Malice will be hardest hit. Mass rural hospital closures aren’t hypothetical.

Unless the Republican-majority Congress stands up to the self-defeating cruelty of this lawless administration, the health care infrastructure that President Barack Obama fought so hard to correct will be broken by design.

Politically, the gamble is as reckless as the policy. Health care is a third rail because voters understand it personally. They may tune out ideological arguments but they don’t ignore a letter telling them their premium just doubled – or that they’re no longer covered at all.

The backlash is going to come quickly, and it should. People will be shocked into action. They’re going to take to the streets, and no one will believe it’s all Joe Biden’s fault. All they’ll understand is that they did nothing more radical than try to stay insured in a system designed to fail them.

In response, the spineless Republicans will do what they’ve always done when faced with a revolt of their own revolting creation: they’ll try to disappear. But they won’t be able to run and hide for long. Sooner rather than later, their own bill will come due.

• Ray Richmond is a longtime journalist/author and an adjunct professor at Chapman University in Orange, CA.