Eternal Vigilance is the Price of Affordable Health Care


When Sen John McCain (R-Ariz.) voted “no” on the “skinny repeal” of the Affordable Care Act, many of us thought that the ACA, “Obamacare,” was safe. We began discussing a true universal healthcare system. The New York Times ran a feature article headed “The Best Health Care System in the World: Which One Would You Pick?” They had a panel of experts compare healthcare systems from around the world to see which was the best (in their opinion). The experts chose France. Meanwhile, the rest of us were considering Sen. Bernie Sanders’ proposal for Medicare for All.

But while the Times was comparing healthcare systems around the world, the Washington Post carried a report, “HHS slashes funding to groups helping ACA consumers enroll by up to 92%.” The money will be taken out of the outreach budget, the money given to organizations who encourage people to enroll in a plan, make the prospective enrollees aware of the open enrollment period. This is vital to the success of the ACA which relies on people buying insurance from private corporations. The corporations make a profit by insuring younger, healthier people whose only claims are for a check-up every year. The profits from these customers offset the losses from insuring older patients or those who have chronic diseases. Without the funding for “navigators” the groups that encourage people to sign up for insurance, ACA won’t be able to function. This could lead to major price increases next year, if the insurance companies are even willing to offer policies in states which haven’t been profitable.

The cuts are not evenly distributed, showing that there’s a penalty for voting Republican. Blue states set up their own exchanges and don’t rely on federal funding, but those that relied on the federal government to set up the exchanges took major hits. South Carolina’s budget was cut by 66% and Louisiana by 81%. Presumably the people in these states will be more receptive to claims that Obamacare is failing, and not trace the problems to sabotage by the Trump administration.

Meanwhile, in Congress, Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana have released the latest, and in many ways the meanest of the Republican efforts to replace Obamacare. On May 3, television host Jimmy Kimmel told his audience that his newborn son was born with a congenital heart condition. ”Before 2014, if you were born with congenital heart disease like my son, there was a good chance you would never be able to get health insurance because you had a preexisting condition. You were born with a preexisting condition, and if your parents didn’t have medical insurance, you might not even live long enough to get denied because of a preexisting condition. … This isn’t football; there are not teams. We are the team; it’s the United States. Don’t let their partisan squabbles divide us on something every decent person wants. We need to care for each other.“

Subsequently, Sen. Cassidy, who is a physician, said that a bill that he was working on would pass the “Jimmy Kimmel test”: “Would a child born with congenital heart disease be able to get everything she or he would need in the first year of life? I want it to pass the Jimmy Kimmel test.”

In fact, the Graham-Cassidy proposal is at once the meanest and most inept proposal to date. It takes all the money that had been spent on the ACA and divides it up into block grants, leaving it up to the states to design their programs. But, there’s a catch. As per the Washington Post, “The catch is that it would be distributed to both states that did expand their Medicaid programs under the ACA and to those that didn’t — meaning large states that expanded would lose billions. An analysis by the liberal Center for Budget and Policy Priorities estimates New York would lose about $19 billion after 10 years, and California would lose nearly $28 billion.” The states that didn’t expand their Medicaid programs, and would see major cuts in their budget to recruit new enrollees would see a windfall, while the states that expanded Medicaid would be starved. It seems unlikely that the Republicans from New York and California, even those who voted for the disastrous Republican American Health Care Act, would go along with Graham-Cassidy.

The Affordable Care Act is complex, but in states that supported it, it has worked very well. Millions of people have health coverage who couldn’t afford it in the past and prices have been lower than the original estimates. We blocked the Republican efforts to undo the ACA with demonstrations and letters — but we can’t stop yet.

Sam Uretsky is a writer and pharmacist living in New York. Email

From The Progressive Populist, October 15, 2017

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