Concerns Over The American Health Care Act
The consensus appears to be that, despite the assurances, premiums will likely increase, deductibles will not improve, and patients could be denied coverage because of pre-existing conditions.
On May 4, 2017, the House of Representatives passed the American Health Care Act by a narrow margin, even though the Congressional Budget Office (CBO) had not officially reviewed and reported on the bill's impact.
This is concerning because it brings into question whether the promises made by the President and Republicans can be fulfilled. At this point, the true impact and cost of the plan is not known.
But the consensus appears to be that, despite the assurances, premiums will likely increase, deductibles will not improve, and patients could be denied coverage because of pre-existing conditions. If that wasn't enough, the bill also threatens to increase our deficit, based on prior reviews of similar Republican healthcare proposals. First, adopting the measure before the CBO review is akin to building a skyscraper based solely on the architectural proposal before structural engineers have confirmed whether the design is likely to collapse under real world physics.
Many are concerned because the bill allegedly allows state governments to waive basic coverage benefits, including maternity care, protections for people with pre-existing conditions, decreased federal insurance subsidies, and cuts in Medicaid support.1 For some patients, those provisions may be lifesaving, and cutting them could pose a threat to the well-being of millions of Americans, especially those who lose their insurance coverage.
While Republicans refute this often-cited Democratic talking point, there is data to support that uninsured patients prior to the Affordable Care Act (ACA) had a higher mortality risk than those who were insured. Controlling for other risk factors, being uninsured carries a hazard ratio of 1.8 compared to insured individuals. That risk has not improved since the 1980s.2
There is clearly a philosophical and political divide in this country that is obstructing the progress of health care. Overall, we are not doing well. For example, among developed nations, we have one of the worst maternal mortality rates — with the risk of death at least 3 times higher than for Canadian mothers.3 This is simply unacceptable.
We have a healthcare system that remains fragmented, is still too expensive for the majority, and still inaccessible to many who need it most. Rather than propose changes to identify pitfalls in the current healthcare law and improve those factors, Republicans have proposed a bill that places us further behind the rest of the developed world, and reverses much of the limited progress that we've made over the last few years.
We can all argue about the general ineffectiveness of the ACA and about specific provisions of the law that overly complicate health care. But there is no arguing that the law has changed health care for the better, particularly for its true beneficiaries — namely those Americans who did not have health insurance through their employers and could not afford to buy individual policies.
The exorbitant costs associated with an individual plan or for a pre-existing condition prior to the implementation of the ACA meant that many individuals went without insurance. For example, in the 1990s my mother lost her job and was quoted a monthly insurance premium for an individual policy that was equal to 50% of the salary she had just lost — just to cover her pre-existing hypertension. In today's post-ACA world, she would have qualified for insurance subsidies and, at the very least, could have found affordable coverage for a catastrophic event.
Part of the unwillingness to work together comes from a general sense of hyper-partisanship in Washington. Party has become more important than country, and both sides are guilty of politicizing issues to promote re-election campaigns and maintain party numbers, both in the House and Senate.
While I do not always agree with either side, Democrats will likely find themselves on the right side of history regarding the issue of health care. The philosophical hatred among many Republicans towards the individual mandate, insurance subsidies, and Medicare expansion — which were removed from the current GOP bill — is unheard of and irrational. They're ignoring the fact that many of their constituents, not their financial sponsors, benefit from those provisions of the ACA.
Rather than pursue a discussion with voters about the aspects of their healthcare plans that they find most frustrating, they side with the corporate interests that would benefit most from a repeal, with or without a replacement. Even more baffling is why the “conservative” party would want to take actions that would result in increasing our deficit when we should be trying to reduce it and build a surplus.
Consider the individual mandate. Republicans do not want citizens contributing towards the health care of another citizen. To illustrate this, consider the response of former Congressman and radio host Joe Walsh to Jimmy Kimmel's plea for better universal access to health care days after Kimmel's son was born with Tetralogy of Fallot. Joe twitted “Sorry Jimmy Kimmel: Your sad story doesn't obligate me or anybody else to pay for somebody else's health care.” Besides being crass, this philosophy ignores the point of how insurance works. Sharing and spreading of risk allows individuals to get the care they need, when they need it, without going bankrupt.
Premiums that are paid into the pool by healthier individuals benefit those who are currently sick. When the healthy individuals become sick, then they, too, benefit from premiums paid by other healthy individuals. Insurance only works if there are mostly healthy individuals paying into it to cover the costs of those members who are sick.
Unfortunately, the lifetime risk of having a major illness in this country is high, and most Americans do not make enough money to sufficiently save for such a catastrophic event. For example, what would an American who is struggling to make student loan payments, while covering daycare expenses, on a minimum wage do with a health savings account? Absolutely nothing.
So, the problem is not about paying for someone else's health care, as Republicans have so crudely put it. Rather, it's about protecting oneself against a potentially life threatening, life changing and bankrupting event. It's about preserving life and maintaining a productive society.
There's no doubt that if people can't get the care they need, their productivity diminishes and society suffers the loss. We are not talking about social welfare, as they like to describe it. We're talking about insuring our democracy and its future success by making sure that every American can remain a healthy, productive member of society.
The second fallacy in Walsh's philosophy is that one can get away from contributing, in some way or another, towards someone else's health care. Even before the ACA, a proportion of our state taxes went towards funding community safety-net hospitals aimed at providing care to indigent populations.
Alternatively, private hospitals that cared for uninsured patients wrote off those unpaid bills as losses, thereby decreasing tax revenue. Regardless of how you look at the issue, all tax-paying Americans pay the bill for those who go uninsured and default on their healthcare expenses.
Compassion doesn't play into it. By requiring individuals to pay into health insurance premiums, the government is not forcing compassion onto people — it is protecting tax-paying Americans from losing their tax revenue that could otherwise be used for things like education, infrastructure, and community development.
As partisan as this argument may seem, my intent is not to promote the Democratic agenda, but rather to make explicit the point that Republicans are not looking at the problems with the ACA, nor are they trying to find real solutions. Their most recent proposals are a testament to that.
The only Americans they seem to serve are those who need the ACA the least. Yet many of the Americans who pledge their undying support to the Republican party often need the ACA more than they realize.
- “The Trumpcare Disaster.” The New York Times. Updated May 4, 2017. Available at: https://www.nytimes.com/2017/05/04/opinion/obamacare-house-vote.html. Accessed May 18, 2017.
- Wilper, Andrew, et al. Health Insurance and Mortality in US Adults. Am J Public Health. 2009;99: 2298-2295.
- Martin N and Montagne R. “Focus on Infants During Childbirth Leaves US Moms In Danger.” NPR. Updated May 12, 2017. Available at: http://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger. Accessed May 18, 2017.