Kudos to President Trump and House Republicans who had the tenacity to push thru healthcare legislation to the detriment of the vast majority of the American people. Kudos to our President and House Republicans who were able to turn a blind eye to the healthcare needs of the people, stayed focused on their political war with Democrats, and lend an extra helping handout to the very rich and the bottom line of businesses. Kudos to Trump and House Republicans who successfully exercised their loathing of Obamacare to not only undermine it, but merrily applauded their success in approving a plan that will kick tens of millions of people off their healthcare insurance and diminish the healthcare policies of the rest of us. Kudos to “leaders” who managed to muster the callousness to vote for the House healthcare bill knowing that it will substantially raise premiums for the vast majority of older people as well as push those with serious pre-existing conditions into health insurance pools that won’t be financially viable.
While the political war in Washington may seem like a lot of political nonsense, no one should be inclined to think this hasn’t and won’t affect them. Even without passage of this legislation, Trump’s constant contention that Obamacare is “exploding” succeeded in undermining it, shaking confidence that the government would maintain the subsidies that are part of it, dissuading insurance companies from entering marketplaces, and rescinding the individual mandate that penalized healthy people who refused to participate. By directing the IRS not to enforce the individual mandate, Trump effectively gave a green light to healthy people who haven’t wanted to enroll in health insurance. This has and continues to tilt the insured pool toward less healthy people, which drives up insurance company costs, drives up premiums, drives insurance companies out of insurance marketplaces, reduces competition and drives up premiums even more. Even without the House legislation that passed May 4th, Trump and those bent on replacing Obamacare have succeeded in seriously undermining it so they can make way for their own plan.
If the “Trumpcare” legislation were enacted, it would pave the way for states to waive the requirement that every healthcare policy in their state include the ten essential benefits delineated in Obamacare (ACA). These include coverage for emergency room care, hospitalization, maternity care, pediatric care, prescription drug care, mental health and substance abuse care, lab tests, preventative services, a cap on out-of-pocket costs and pre-existing conditions. Under the House passed legislation, when states decide to “opt out” those benefits cannot only be taken away from those who bought healthcare insurance through ACA, they can be taken out of employer sponsored health insurance plans. While some might think that’s a good way to reduce premiums, many people would be left with serious gaps in coverage and in serious financial peril when they need healthcare that is not part of their plan.
While reductions in the scope of coverage under Trumpcare could lead to a reduction in premiums, it would not be surprising if even this ill-conceived effort does not pan out. The elimination of the individual mandate requiring young adults to be part of insurance pools will likely put upward pressure on premiums. The cap on premiums people in the 50’s and 60’s pay will also rise from three times what those in their 20’s pay, to five times what people in their 20’s pay. So, while premiums may go down for young adults, for people in their 50’s and older will likely experience a double whammy of rising premiums and reduced coverage.
If the Trumpcare plan were enacted an estimated 24 million people would lose their health insurance by 2026. This includes seven million fewer people on employment based health insurance and another three million fewer people with health insurance through the individual marketplace. These estimated reductions will result from Trumpcare rescinding both the employer and the individual mandates, reductions in tax credits and subsidies for low and middle income families, and a whopping $880 billion reduction in Medicaid funding over the next 10 years. While the number of people losing their health insurance may seem like just a lot numbers, they represent real people and families and very serious consequences for them.
Lest anyone be concerned that Trumpcare has little benefits associated with it, we ought to recognize that an estimated $883 billion in tax breaks will be given out. The richest 2% among us will get $275 billion in tax cuts over the next 10 years, including a $50,000 per year tax cut for those earning $1 million per year. The 400 richest families in America would get a tax cut averaging $7 million per year. Insurance companies and drug companies will also get tax breaks totaling $170 billion. This may all sound like a “Great, Great!” plan to Trump, millionaires, billionaires, CEOs, and far right ideologues, if enacted Trumpcare would be disastrous for tens of millions of families and put serious financial and healthcare pressures on the rest of us.
While it is clear that Obamacare is far from perfect, what is needed now are pragmatic remedies to its flaws and expanding it to include all Americans. Given all indications that Trump simply can’t get past his utter disdain for Obamacare and his Machiavellian efforts to usher in its collapse, our last hope for improving healthcare seems to lie with fair minded moderates in the Senate.
The cost of health insurance and the number of people covered can substantially improve if the Senate focuses on implementing a number of pragmatic things that care be done. The cost of healthcare can be brought down through lower negotiated prices for prescription drugs, as well as rewarding doctors and hospitals for the quality of care they provide. Programs that help doctors and hospitals improve the quality of care need to continue. Fund of community healthcare centers needs to not only continue but grow. We need more people to sign up for health insurance by providing greater availability of enrollment assistance for those trying to sign up and compelling healthy people to participate in health insurance by not only re-instating the individual mandate, but enforcing it with penalties equal the cost of insurance. We need to shore up confidence that federal subsidies will be maintained and foster insurance company participation in marketplaces. We need to lower the age for enrollment in Medicare down to 60 years old. And we need the leadership in the 19 states that have so far refused to accept additional Medicaid funding to expand Medicaid to the benefit of their people. States such as Ohio, which embraced the ACA and Medicaid expansion, has one of the lowest percentage of our population uninsured (6% vs 16% in Texas which refused Medicaid expansion). Because our leadership in Ohio embraced implementation of the ACA, we have a relatively large number of insurers competing for enrollees and insurance premium hikes have been kept significantly lower than states that have been hostile to implementing the ACA.
As we and our leaders consider the options before us, let me suggest that taking care of “widows and orphans”, those that are poor and in need of help, as well as the middle class looking for a little security and a fighting chance to live a decent life, be foremost in our minds. Mercy, compassion and protecting everyday people must be one of the cornerstones to policy options being drafted. As President Trump and House Republicans celebrate their success passing new healthcare legislation, it would be good of them and those that will be debating these issues, not to forget the good council of Solomon who said: “Those who mock the poor insult their Maker; those who are glad at calamity will not go unpunished.”