In a post yesterday, I quoted an age-old expression, “Don’t throw out the baby with the bathwater”. Today, I find it appropriate to use again. Today I am ruminating on the Affordable Care Act ACA) and the 115th Congress’ and incoming president’s determination to throw out that particular “baby”.
Throughout his campaign last year, Trump has claimed that he will “dismantle” ACA on his first day in office, and replace it with something better. In fact, he claimed that he would replace it with something “great” that everybody would love and that would cost the government far less than ACA. But every time an interviewer asked him for specifics, he reverted back to criticism of ACA without offering so much as a glimpse into what his “great plan” might be. Now, as he is just two weeks away from taking office, he is still intent on dismantling ACA immediately, and still has offered no alternative plan. Republicans in Congress, however, have taken up the call and are busily working on a plan to dismantle ACA.
Congress’ plan to repeal ACA is a four-step process:
- Pass a resolution that would cut ACA provisions from the budget, while also disallowing a filibuster by Democrats in protest of the resolution.
- Draft legislation that would:
- ■ Eliminate the tax penalties imposed on people who go without insurance and on larger employers who do not offer coverage to employees.
- ■ Eliminate tens of billions of dollars provided each year to states that have expanded eligibility for Medicaid.
- ■ Repeal subsidies for private health insurance coverage obtained through the public marketplaces known as exchanges.
- Draft a series of executive orders that Trump will put into effect to ensure that there is an orderly transition, during the period after we repeal Obamacare, to a market-based health care economy
- Find a replacement for ACA (thus far there is no consensus … no plan)
With two weeks to go until Trump’s inauguration, Congress has a definite plan for gutting the current healthcare law, but not so much as an inkling of what Trumps “great” replacement plan would look like, nor any idea how it would be funded or implemented.
I am insurance-illiterate, so I will not even attempt to discuss the various sections of ACA and the ability of Congress or Trump to repeal them, but I have read a few articles that claim it could be difficult for Congress to repeal the entire act, although there are parts that they can repeal with a simple majority. And other parts Trump himself can repeal with the stroke of a pen. Many experts have said that repealing the health law without a clear plan to replace it could create havoc in insurance markets.
What does this mean for the 20 million people who have health insurance through the individual Obamacare exchanges or Medicaid expansion? It seems uncertain to predict, without knowing what, if any, replacement plan will be put in place. My best guess is there will be no replacement plan in the immediate future, since the rough draft of said plan does not yet exist. That means that those 20 million people will be left without insurance and without the means to obtain medical treatment. It may also mean that people with pre-existing conditions will be unable to obtain insurance.
But the damage goes well beyond those 20 million people. According to an article by CNN Money, “The ACA made changes in every part of the health care system,” said Larry Levitt, senior vice president at the Kaiser Family Foundation, of the Affordable Care Act. “Virtually everyone has been touched by the ACA.”
Some of the effects of repealing ACA would be:
- Dismantling Obamacare would likely mean higher premiums, deductibles and cost-sharing for the 57 million senior citizens and disabled Americans enrolled in the program. Medicare beneficiaries would pay more because premiums and deductibles are tied to the growth of federal outlays. So seniors would face higher deductibles and co-payments for their Part A, which covers hospital stays, and higher premiums and deductibles for Part B, which pays for doctor visits and other services. Higher-income enrollees, however, would see some financial benefit from repeal. Obamacare froze the threshold for the Medicare premium surcharge at $85,000 for individuals and $170,000 for couples, so more people have become subject to it. The law also added a premium surcharge on drug coverage for wealthier beneficiaries.
- Companies with at least 50 employees would no longer be required to provide affordable insurance to their staffers who work more than 30 hours a week. Also, companies would no longer have to keep children on their parents’ plans until they turn 26. Insurers would once again be able to ban workers with pre-existing conditions, or require them to pay significantly higher premiums.
- Insurance companies will once again be able to place annual or lifetime caps on both benefits and out-of-pocket costs. Insurers will also once again be able to charge women more.
Ever since the Affordable Care Act passed in March 2010, complaints have been widespread and annoyingly loud. Granted, there are problems with ACA, commonly known as Obamacare. Some of the legitimate complaints include rate increases, employers altering the plans they offer, inconsistency among states in Medicaid expansion, and others. The middle class claims it is unfair, that it benefits mostly low-income, poverty-level, and unemployed people. All of which are legitimate concerns and need to be addressed. I would argue, however, that fixing the problems while leaving the foundation in place makes more sense than tossing the entire plan out while pondering and bickering over what the new plan might be. An analogy might be if you have a car that needs a new radiator, do you replace the radiator, or scrap the entire car? Personally, I would rather invest in a new radiator than a new car.
Despite the grumbling and complaining from the public, the nation is actually quite divided over ACA. According to the Kaiser Family Foundatio (KFF), a reputable non-profit organization that focuses on healthcare issues, almost 50% of the nation favours either expanding ACA or maintaining the current law or maintaining the status quo. Of the other 50%, only 26% favour repealing the law entirely. So, that said, it would appear that Trump and the Republicans in Congress are completely oblivious and uncaring about the wishes of their constituents!
While I promised a few days ago to try to cut back on my snarkiness and be less critical, at this point I must emit one small rant, else I shall burst into a thousand pieces.
“To everyone who voted for Donald Trump on or before November 8th: On behalf of every man, woman and child in the United States … THANKS A WHOLE HELL OF A LOT!”
Whew. I feel better now. Thank you, dear readers, for allowing me a slight rant.
I highly recommend a visit to the Kaiser Family Foundation website, as I found much valuable information there. This is an issue that affects us all, and we need to stay abreast of the situation and understand what is happening that concerns our ability to be healthy and, let’s face it, to stay alive.
Those who are retired, like myself, and dependent on Medicare for their basic healthcare needs, will suffer. Those who cannot afford to spend $200+ per month to purchase health insurance will suffer. Women will suffer. The only people who will not suffer are members of Congress, Donald Trump, and those whose net worth is six digits or more. The rest of us will likely end up worse off than we were prior to 2010. Every single member of the House of Representatives was elected on November 8th by people who expected their representative to act in their best interest. One-third of the senators were elected on November 8th by citizens who thought the person they were voting for would act in their best interest. And Donald Trump was elected on November 8th by people who were lied to and who fell for the lies that he would improve their lives. We now understand that instead, Trump and the Republicans in Congress have no interest in our lives, but rather care only for improving the net worth of their wealthy friends. Shame on them all.