The Health of Our Care – The Very Best Ever in the History of the World, Or Not

So, it’s here, the GOP’s replacement plan for the Affordable Care Act. In my last two posts, I wrote a whole lot about pre-existing conditions. The GOP’s plan – potentially called the American Health Care Act, not really called The World’s Greatest Healthcare Plan Act of 2017 (that was the name of another potential GOP replacement plan, not actually chosen), but so far, no one quite knows what to call it – leaves in place the no pre-existing condition clause of ACA, sort of, so you’d think I’d be happy. I’m not.

It’s true that the new plan prohibits insurers from refusing coverage to anyone with pre-existing conditions (which can be anything from cancer, heart conditions, to high cholesterol, to eczema, to overweight, to backaches – it’s their call), as long as you don’t fall behind on payments and miss 2 months. Then you’ll get at least a 30% increase in premiums.

The individual mandate is gone. So now, young people, or anybody who’s feeling lucky can refuse to purchase health insurance. And when they get sick, and some of them will, or fall down the stairs when they’re drunk, or get hit by a limb on a windy day, or spill hot water on their kid while cooking, they will go to the hospital. And maybe they’ll be able to pay the bill. And maybe they won’t – because, after all, these are people who don’t have the money to pay monthly bills. But the hospitals will treat them anyway. And the hospitals just eat some of the cost themselves and pass some of it along to everyone else in the form of higher costs. So our costs will go up, the hospitals’ operating costs will go up again, causing many of them to close – again – especially small town and rural hospitals (something to think about for all those lamenting the rural opioid epidemic). But no one will be told they have to have insurance.

Replacing the mandate and its income-based tax credits is a new plan of tax cuts based on age – older people getting more of a cut than younger folks – and it’s a flat rate no matter whether you live in a market with higher premiums (like many rural areas, as well as NY/NJ). The problem is that insurers are now allowed to raise premiums based on age. The AARP estimates that adults in their 50s and 60s will see increases of 5 times current premiums or more – many thousands of dollars per year – which will not be offset by the small tax cuts offered in the plan.

In addition, there is nothing to keep insurers from once again jacking up premiums for sick people. One important part of the ACA was that 80% of premium cost had to go toward medical costs. Therefore, I knew that even if my premium went up, it was actually going to cover healthcare costs, not lobbying or executive pay. (As I’ve written about in the past, before ACA, my premium increases were going to pay for executive pay increases in the multiple hundreds of %. I don’t know about you, but I don’t get increases like that. If I’m lucky, I get a 2% increase.)

Other key provisions: funding for public health will be gutted (important for you next time there’s an outbreak of something in your area – or your kids’ schools), Medicaid will be gutted and the expansion halted and rolled back, and taxes which are helping shore up Medicare are gone (important for you younger folks who don’t want to pay for health insurance because this increases the likelihood that there will be no safety net for you when you’re old and do need healthcare). Insurers are welcome to go back to what amounted to scam policies – very cheap policies which covered basically nothing – the ones people who had never actually had to use were very happy with – the ones the lots of people discovered covered almost nothing only after they got sick. Under ACA, there was a minimum level that all policies had to cover. The plan does give big tax breaks to wealthy people, though, especially to insurance execs making over $500,000 (which is pretty much all of them). And it gives a big tax break to the tanning industry – an industry which is based on an activity known to cause cancer. and lifetime caps will be back.

Were there problems with ACA? Yes, certainly. But, according to the NY Times, only 3% of Americans have actually seen big increases in their premiums with ACA – 3%. This plan will hurt lots of Americans. This plan helps a lot of wealthy people and corporations. This plan will damage the ability of Americans to afford health care. The rules apply to the individual market, but will affect employer plans as well – lifetime caps, no covered routine exams/scans, premium increases going to cover company expenses rather than healthcare….

So much has been said about “access” to healthcare. Well, access doesn’t do a damn bit of good if you can’t afford it. This plan will break the bank for many of the people who need it most. I think it’s time for me to tell a little more of my experience before ACA, my experience with the “market” for individual health insurance.

I had insurance (sometimes when I was young doing things like always walking to work so I could save subway fare, or doing my laundry by hand in the bathroom sink – all so I could afford health insurance as well as rent and food, you know, young struggling musician sort of things). I got hit by a taxi, resulting in a spinal cord injury. I recovered, with a lot of PT and surgery – all covered because the driver had insurance which is mandated for drivers (and no one seems to object to that insurance mandate). Then I got cancer. And I got treatment. And I didn’t die.

But my premiums started going up. And up. And up. I recently pulled out my old taxes. While I was sick, my medical costs were around 50% of my income – the larger portion being out-of-pocket expenses. Within a few years, my medical costs went up to 60, 70, 85% of my income – with the balance of the expense being insurance premiums rather than other expenses. And finally, my healthcare costs went up to around 118% of my income. Yes, that’s right. My medical costs, and it was mostly just insurance premiums, were more than I made (granted, I had lost a lot of work while I was sick, and the economy was down, but still…). I was healthy by then, no longer in treatment, but I had had cancer.

That is not sustainable.

This next thing is really hard for me to say, to write, publicly. I was lucky, I had some savings, and I lived with someone who was able to shoulder our shared expenses. But – and here it is – if I hadn’t happened to live with someone, I would have either been homeless or dead. I pride myself in my independence, in my self-reliance. I can take care of myself. But I was fully dependent on the ability of someone else to provide me with a place to live and eat. Because all of my money and then some was going to my health insurance premiums. If I weren’t so “lucky,” I would be homeless or dead. Homeless. Dead. Or I would have sold all my belongings, gone on public assistance, and not earned money, not paid taxes, not contributed to society in the same way I have. Homeless. Dead.

That is the reality of what the market was like for individuals before ACA. That will be the reality again for millions. And that is why, so far, the AARP, and all major associations representing doctors, insurers, nurses, hospitals – basically, anyone who actually cares for sick people – have come out strongly against this plan, saying they cannot support a plan which so clearly hurts the vulnerable in our society – the sick, the poor, and older adults. So, no, this does not make me happy. My premiums will likely go up many thousands of dollars, but I’ll probably be OK, I’ll have insurance – and I have savings. But many millions of Americans will be hurt. Many will have to go without insurance. Many hospitals and doctors will still care for them. And then many of those hospitals will close.

In the meantime, members of the GOP have said people just need to not buy cellphones (I might point out that a new iPhone would only have covered around 1/4 to 1/3 of my pre-ACA premiums, so not sure what that would do), that people who have been sick are like houses burned to the ground, that it’s good for America if more people are uninsured. But I guess their golfing buddies are happy.

Oh, that was snarky, wasn’t it? Too bad, I’m tired of being polite. I am not happy.

I almost didn’t write this post. Yesterday, I was too depressed. And too weary. I know the insults that will be hurled at me because of my opinions on this policy – because I’ve heard them too many times before. Yesterday, out for a hike, I said I wasn’t sure I was up for that again, not that I was afraid of the trolls, just weary. And that’s not good.

So I’m writing, and I’m being snarky because the callousness and hypocrisy of all of this. I’m writing, and I’m ready for the insults, the names, the threats. I’ve been called a bitch, stupid, stupid fucking bitch, know-nothing, fool, idiot, leftist, libtard, should have died, am not a real woman because I had breast cancer…. I just wasn’t sure I wanted to wade back into that again. But I am. Because this is a bad plan. Because it is unacceptable to me that, once again, people who have had the bad fortune to get sick will have to pay more than their income for insurance. That people will have to choose between food for their kids and their own medicine. That people will lose homes because they got injured (remember, 50-60% of foreclosures in the housing crisis were directly attributable to healthcare – people who might have gotten by couldn’t because they or their kid or spouse got sick or hurt).

So bring on your worst. Threaten me. Call me names. No matter what, I will continue to say this is bad policy. This damages Americans. This will damage the economy. This will damage American families. This bill will hurt people while the wealthy get an extra vacation.

But if you’re interested in reading actual facts, I recommend you check out the Kaiser Family Foundation for a whole lot of detailed info. Or read the AARP’s letter to Congress. And here’s a good overview from NPR.


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