Introducing Trumpcare

Yesterday, House Republicans revealed their plans to replace Obamacare, otherwise known as the Affordable Care Act (ACA), with their own remedy, the American Health Care Act (AHCA), soon to be known as Trumpcare.

The good news: the AHCA still mandates that people with pre-existing medical conditions cannot be denied insurance coverage, and that insurers cannot charge them more due to their health. The bad news: It may become more difficult to find robust policies that offer the comprehensive coverage needed by people with chronic health concerns.

Some of the proposed provisions of the new legislation do not go into effect until 2018 (after the mid-term elections) or 2020 (after the next presidential election). Here’s a round-up of some of the best reporting and analysis I’ve found so far:

Washington Post  House Republicans release long-awaited plan to replace Obamacare  3-6-17

New York Times   The Parts of Obamacare Republicans Will Keep, Change or Discard  3-6-17

CNN Money   Republicans’ Obamacare replacement bill: The winners and losers  3-6-17

Forbes   Republican Health Care Plan’s Continuous Coverage Idea Needs a Redraft 3-6-17

We have a long way to go before this issue is resolved. Four Republican Senators have already expressed their concerns about the House proposal, and the Democrats are promising a fight. Somehow, someway, I sincerely hope we can get past the partisan wrangling to come up with a solution that truly works for all Americans. It’s not going to be easy, and it certainly is not going to be quick.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Image Credit: Motion Studios

Existing Conditions

With the presidential inauguration only a few days away and the Republican-controlled Congress on a fast track to repeal the Affordable Care Act, it’s essential for all of us who live with chronic diseases to understand what’s happening to health insurance coverage. Much is still in flux. I have been staying up far too late recently, reading the most reliable sources I can find to follow the pace and direction of “repeal and replace” of Obamacare.

I do not intend to turn this blog into a political forum on the issue. However, I will confess that I am deeply alarmed by what’s happening in Washington and what I perceive as the significant risks of repealing a flawed but beneficial law with no clear plan to replace it. The drafting of the ACA involved many participants in the health care system. Its replacement deserves similar, deep discussion and debate, and enough time to consider all the implications—especially for the millions of Americans who may now lose health insurance without the means to purchase needed coverage, if insurance subsidies provided under the ACA are eliminated.

The procedural rules that Republicans are using to push through reform are complex. The process of ACA repeal began last week with a special budget process called reconciliation, which requires only a simple 51-49 majority in the Senate and precludes filibuster by opponents. In accordance, both Houses passed a blueprint for repealing Obamacare. There is a long way yet to go. Here is a January 13, 2017 article by Margot Sanger-Katz from the New York Times that explains all the steps: Obamacare Repeal is Moving Forward. When Will Changes Affect Consumers?  As she notes, it’s highly unlikely that those currently covered by the ACA will feel the effects this year of a potential repeal.

I have been very fortunate to have excellent health insurance through my husband’s employer. Since I work for myself, buying private insurance, even in Massachusetts, which created the prototype for Obamacare, is expensive. But I know I can get it if I need to, even though I’ve had scleroderma for more than three decades.

At stake for so many out there with serious health issues is the pre-existing condition protection provided by the ACA. So far, the president-elect has expressed an interest in preserving this aspect of the law. But, it’s complicated. Here is an excerpt from another piece by Sanger-Katz, explaining what’s at stake. You can read the full article here: The Biggest Changes Obamacare Made, and Those That May Disappear

One of the law’s signature features prevents insurance companies from denying coverage or charging a higher price to someone with a pre-existing health problem. The law included a host of other protections for all health plans: a ban on setting a lifetime limit on how much an insurer has to pay to cover someone; a requirement that insurers offer a minimum package of benefits; a guarantee that preventive health services be covered without a co-payment; a cap on insurance company profits; and limits on how much more insurers can charge older people than younger people. The law also required insurance plans to allow adult children to stay on their parents’ policies until age 26.

What would happen? These rules can’t be changed using the special budget process, so they would stay in place for now. But eliminating some of the other provisions, like the subsidies, and leaving the insurance rules could create turmoil in the insurance markets, since sick customers would have a much stronger incentive to stay covered when premiums rise.

What might replace it? Mr. Trump has said that he’d like to keep the law’s policies on pre-existing conditions and family coverage for young adults, but Senate Republicans recently voted against nonbinding resolutions to preserve those measures, suggesting they may be less committed. Some of the other provisions would probably be on the table if there were new legislation. Republicans in Congress would probably eliminate rules that require a minimum package of benefits for all insurance plans and allow states to determine what insurers would have to include. Mr. Trump has said he’d like to encourage the sale of insurance across state lines, a policy likely to make coverage more skimpy but less expensive for many customers. Republicans would also like to expand tax incentives for people to save money for health expenses.

Many of the Republican proposals would also establish so-called high-risk pools, which would provide subsidized insurance options for people with chronic health problems who wouldn’t be able to buy insurance without rules forcing insurers to sell them coverage.

The debate is far from over. We each have an opportunity to express our views to our congressional representatives. Whatever your opinion on this subject, please read beyond tweets and headlines, be informed and willing to listen to other points of view, and make your voice heard.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Image Credit: Pablo Garcia Saldaña

Pre-exisiting Conditions

Be forewarned: This is a rant.

Where are the grown-ups in Congress? Can we please go back to the days when people with strong opinions had the maturity to speak to one another and negotiate a compromise?

I had a hard time concentrating on my work this past week, with all the school-yard bullying on Capitol Hill that caused millions of hard-working federal employees to sit idle and worry about their next paychecks, while right-wing conservatives insisted they wouldn’t fund the federal budget unless they could gut the Affordable Care Act.

Then, with Orwellian ease, these same Tea Party Republicans turned around and began to press legislation to fund, piecemeal, all the government programs they realized their constituents valued, after all. Like the National Institute of Health. And help for poor women who can’t afford to feed their children. And blamed it all on the Democrats. Really? How stupid do they think we are?

Whatever your opinion about Obamacare, this is not the way to resolve it. The new law may have flaws that need to be worked out, but it also has already helped millions of children with pre-existing conditions to get health care coverage, something the free market has failed to do. And it promises to help millions of American adults with chronic illnesses like scleroderma to get necessary medical care that they could not otherwise afford. So many people tried to check out the new insurance exchanges this past week that websites across the country couldn’t handle the load. Clearly, demand is real and significant.

But there are so many lies, so much misinformation being perpetrated by a conservative coalition backed in large part by the Koch brothers, billionaire oil magnates whose corporate holdings include Brawny paper towels, Dixie cups and Georgia-Pacific lumber, among other profit centers. This past Sunday’s New York Times explains the months-long machinations that have led to the current standoff.

Even the idol of conservative Republicans, Ronald Regan, knew how to negotiate with House leader and died-in-the-wool liberal Democrat Tip O’Neill. Take a page from the Gipper’s playbook, Tea Party members, and let us get on with the real work of governing. Please.

What disturbs me as much as this hostage-taking political brinksmanship inside the Beltway is the cynical effort by this same conservative coalition to undermine the law’s effectiveness by trying to convince young, healthy Americans, especially college students, not to enroll in Obamacare.

The program’s long-term success depends on everyone, healthy or not, to participate and spread the risk. Where is our good old American compassion? Our sense of community and responsibility for each other? Not to mention the fact that young adults shouldn’t be boondoggled into thinking they can do without healthcare coverage. That is just pure foolishness. An emergency room visit for a broken ankle or dehydration from the flu—the kinds of medical crises that can strike anyone, regardless of age or medical condition—can easily cost several thousand dollars, far more than most young adults can afford. And it’s certainly smarter to get healthcare coverage when you’re young and healthy—otherwise you run the risk of being denied coverage when you get really sick.

It’s that pre-existing condition Catch-22.

Health insurance isn’t the only type of coverage that currently penalizes those of us who struggle with chronic disease. I cannot get affordable long term care insurance, something I may well need in the future. My scleroderma makes the premiums outrageously high. I also cannot add to my life insurance, which I fortunately had the foresight to buy when I was still healthy and in my twenties. But my coverage is modest, what I could afford back then.

I’m sure it will be years, probably decades, before those free market inequities are addressed. Meanwhile, I am praying that Congress and the President are able to work out their differences, get our dedicated federal employees back on the job, avoid the major catastrophe of a default on the nation’s debt payments, and refine the Affordable Care Act as needed without any more childish shenanigans.

I love our system of democracy. The older I get, the more I value the freedoms we enjoy. It’s high time for the principled adults to stand up to the egotistical ideologues, take back Congress and work together to solve the very serious issues we all face as a nation.

Photo Credit: kenteegardin via Compfight cc

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.