Friday, March 10, 2017

Health care is, by definition, life and death.

Allow me to begin this week's installment of "Oh-My-God-HOW-Many-Promises-Did-I-Commit-to-Writing-About?!" with the acknowledgement that I know very, very little about health care in the United States. It is, as President Trump recently acknowledged, complicated.

I have a cursory understanding of how subsidies introduced by the Affordable Care Act (alias Obamacare) allow me to pay simultaneously for health insurance and rent, which is delightful. I know people who, due to pre-existing conditions, only have coverage because of the ACA. I know that Medicare is for the elderly, Medicaid for the poor. I know that President Trump promised quite vigorously to keep both of them intact.

In terms of health care reform, he also promised to eliminate the individual mandate (#53) and increase doctor choice (#64). Unless my feeble woman-brain is mistaken, doesn't one need health care coverage to go to a doctor at all?

Pause and reflect.

The American Health Care Act, or Trumpcare, as it has been dubbed, recently passed through two committees in the House of Representatives. If passed in its current form by the House and the Senate, it will disproportionately impact (that is to say, hurt) the people who voted for Trump believing in his promises to improve, not annihilate, their access to health care.

The "for dummies" (myself included) low-down on the American Health Care Act is this: lower taxes on the ultra-rich, less health care for the poor. In no particular order:

  • Lower-income individuals and will lose access to health care. While the ACA raised the Medicaid income eligibility ceiling to $16,400 and provided generous insurance subsidies to those making less than $30,000, much of that will be reversed by AHCA. (Is that what we're calling it now? Or is it Trumpcare? Wealth Care, perhaps?)
  • Insurance companies whose CEOs make more than $500,000 will receive a tax break that will, over the next 10 years, amount to $400 million in lost tax revenue. This is a huge deal, not just because of the principle behind it, but because it proves an unwillingness to maintain -- much less grow -- health care spending enough to fund Trump's promise of higher-quality, less expensive health care for all.
  • No more individual mandate, i.e. no more penalization of those who don't enroll. However, to cover the revenue gap, insurers will be allowed to "impose a surcharge of 30 percent for those who have a gap between health plans."
  • They'd keep two very popular pieces: Young adults would be able to stay on their parents' health plans until the age of 26, and insurers would not be able to deny coverage or charge more based on pre-existing conditions. (They would, however, be able to charge their oldest customers up to 5x what they charge their youngest. The ACA set that limit at 3x.)
  • Planned Parenthood, whose services include anemia testing, cholesterol screening, high blood pressure screening, diabetes screening, physical exams, flu vaccines, help with quitting smoking, thyroid screening, tetanus vaccines, sex education and counseling (including abortion counseling, family planning counseling, and STD testing), cancer screenings, psychological support, and relationship counseling, among other things, would be ineligible for Medicaid reimbursements or federal family planning grants. While not surprising, this is still devastating -- especially for the poor, and especially for poorer women.

Who's speaking out against Trumpcare?

For the full list and its members' reasoning, check out this piece in Mother Jones, makers of the exceptionally comfortable "Fight Like Hell" t-shirt my mom gave me when she came to visit the other week.

Here's the quick 'n' dirty version:
- Senator Rob Portman (R-OH)
- Senator Shelley Moore Capito (R-WV)
- Senator Cory Gardner (R-CO)
- Senator Lisa Murkowski (R-AL)
- Senator Rand Paul (R-KY)
- Senator Mike Lee (R-UT)
- Representative Thomas Massie (R-KY)
- The House Freedom Caucus
- Americans for Prosperity
- Heritage Action for America
- FreedomWorks
- Club for Growth
- CATO Institute
- Breitbart
- National Review
- The American Medical Association
- The American Hospital Association (and six other hospital groups)
- The American Nurses Association
- The AARP
- Ann Coulter

What can we do about it?

We learned last year not to shut our eyes and assume the Republican Party can't get out of its own way. We cannot back down.

I've said it before, and I'll say it again: call your representatives. Politely and concisely explain that the proposed repeal of the Affordable Care Act will not only disappoint many of their constituents, but literally kill some of them. This is dramatic, and it is true.

Access to health care is, by definition, a matter of life and death.

Make it easy using the much-touted 5 Calls app. If your representative's Washington, D.C. inbox is full and hasn't been accepting messages since November -- I'm looking at you, Marco Rubio -- call one of their state offices, one of which will always pick up.

And, as I told a friend the other day after she ranted for an hour about neo-colonialism, "Feel better. Stay angry, but feel better."

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