Today's Vote: Grab Bag Healthcare Reform
The American Health Care Act...
Do you know exactly what your representatives are voting for today? I'm guessing no.
And here's why. Paul Ryan and friends are still frantically revising the bill to achieve party support. There's the eleventh hour, and then there's the eleventh hour.
For a month we have been hearing about the Republican Party's AHCA, the first of three steps towards repealing the Affordable Care Act (Obamacare). Republicans have been against the ACA since it was first proposed, and many ran in 2016 elections on the platform of promptly repealing and replacing it. With campaigning in the rear view, now Congress is facing a complicated reality. Here's the scoop: Congress lacks adequate Republican votes to fully repeal and replace the ACA.
So they are seeking a three prong approach.
Step 1: Guised as Budget Reconciliation, much of the ACA can be repealed or tweaked, particularly elements that are tax-related. This is seen in the current American Health Care Act Bill (more on that in a minute...).
Step 2: Executive Orders
Step 3: Further legislation from Congress
But first, this...
It was not an easy decision, bringing this discussion to the Pink Door House. After all, it's politics. And politics can be so polarizing.
One of our objectives with the blog is to offer a safe place to land for friends and family members of, and especially those diagnosed with, Inflammatory Breast Cancer.
But we also made a promise to ourselves. To advocate. To create awareness. To use our story any way we can to clear some of the rubble from the path for those coming behind us.
Sometimes that means kicking a few stones aside. But this part of the path is overgrown. It's confusing. Controversial. We need to cut back some brush and let a little light through to find our footing together.
When I received my IBC diagnosis, there was no question that we would climb any mountain to return me to health so I could raise my babies. Do you want to know a secret? I didn't even ask if Cancer Care Northwest was in our healthcare plan's network. For two reasons. First, I had been told this was the best local care I could receive. Second, I Had Just Been Diagnosed With Freaking Cancer! I didn't have the mental or emotional energy, or the time, to spend competitive shopping providers. My biopsy results came back Monday, by Friday my port was placed. Tick tock.
When you rate what's most important for you and your family, my guess is that health and happiness float somewhere near the top. As a member of the cancer community, I can't help but wonder why, as a society, we don't consider healthcare a basic right?
In January, the president boldly promised everyone will be covered.
That coverage will be better, less expensive.
Lawmakers are now scrambling to mold this into something feasible.
Enter the American Health Care Act.
Just in case you're not like me, unwinding most nights with a cup of mint tea and articles about health care policy, let me offer a high level view of what would change with the AHCA. In red are recent, major revisions. Keep in mind as of early afternoon on Capitol Hill...on the day of the vote...negotiations are still underway.
Tax Credits vs. Subsidies
The current ACA subsidies to help afford marketplace insurance plans, based on income and local insurance costs, would be replaced by age-based tax credits. More middle and upper-middle class Americans would receive tax write-offs, but older Americans (because the plan softens limits on how much more insurance companies can charge older people), the poor, and those in rural areas (which have high insurance costs) would receive much less support...potentially pricing them out of the market altogether.
To ease the burden on older Americans, the AHCA now has a placeholder, an asterisk, if you will, setting aside approximately $85 billion dollars to do something (unspecified) to help those aged 54-60.
No individual mandate.
Imagine a bucket. We all pay our premiums into the same bucket, and when a medical claim is made, our insurance company dips into that bucket to pay providers. If the AHCA passes, the flow into that bucket will get turned down. Way down. The new incentive to carry health insurance as a healthy individual would be a surcharge of 30% if you allow your coverage to lapse more than two months, and then reenter the insurance market.
Discontinue requiring large employers to offer healthcare benefits.
Defund Planned Parenthood.
End Medicaid expansion in 2020.
Also set per capita limits on how much assistance the federal government offers states for Medicaid consumers. State governments pushed back on this, so the per capita was revised to a block grant.
Protections currently set to remain (from the ACA) include:
Allowing anyone up to age 26 to remain on their parent's health insurance.
Requiring insurers to cover anyone regardless of pre-existing health conditions.
Not allowing annual or lifetime caps to be imposed by insurers.
Requiring providers to offer plans with coverage for the ACA's 10 essential health benefits.
This essential health benefits are under hot debate to appeal to more conservative representatives. It has the potential to move the needle on individual marketplace premium costs. It also does not move the needle on overall federal budget, which very well might disqualify it from the current bill. (Remember our 3-prong appeal approach.)
I've been holding my breath regarding the coverage of pre-existing conditions and the ban on caps. In fact, upon hearing that they will be protected, I considered an early retirement from this mentally exhausting subject.
Now, we frankly have no idea what may or may not land on the cutting room floor by day's end.
Conservative Republicans hate the AHCA, calling it the biggest Republican Welfare plan ever written, and Obamacare 2.0.
Moderate Republicans hate the AHCA because 26 million people losing coverage is too many. In addition, premiums are predicted to rise faster for poorer coverage options. The bill would hurt many of their constituents. (In fact, Trump's base stands to lose the most if the AHCA passes.)
What will be cut, or added, to try and appeal to enough representatives to win the vote? It's Grab Bag policy making. They are throwing wet spaghetti at the wall, seeing what sticks. Will my pre-existing condition be covered? Will the ban on caps stick to the wall long enough?
And here's the thing...I don't have it in me to care so much about my own healthcare, and not at all about someone else's. Especially when many of those "someone else's" are other cancer patients.
As I work to understand the politics of healthcare, I've learned that no matter what system we pursue, there are truly winners and losers.
Single payer, universal coverage ala Bernie Sanders? The sick and the poor are covered. People with chronic conditions can stop worrying about healthcare. Winning. But healthy and affluent Americans would "lose" because they are putting more into the bucket then they are taking out. Insurance providers face more regulations. We all pay taxes on tanning and Tylenol.
More choice and less regulation? Insurance companies and pharmaceuticals win. Anyone healthy enough to forgo coverage, or choose minimally, keeps more of their hard-earned money. The wealthy needn't feel they are pulling along the poor. But the "losers" in this system are those who cannot afford coverage in the first place, or cannot afford to keep their coverage when serious illness strikes.
So I guess the question becomes: what kind of society do we want to be?
I can view the issue though a conservative lens. Rewarding hard work. You care for yours. Natural selection, even. I've heard it argued that like home ownership, health care simply can't be afforded by everyone. That it is a luxury, not a right. This worldview fit me like borrowed cardboard 3-D movie-theater glasses. It's a luxury to not die when you get sick?
The day I was diagnosed with cancer, I guess I staked my tent on more progressive lines.
I mean, seriously.
Natural selection works in the wetlands...but we're talking humanity here.
As a sick American who is first a wife, mother, sister, daughter, and friend, I believe we all win when we are all healthy.
Don't let our representatives repeal the ACA in haste, out of spite or to mark a W in their column. Healthcare reform needs to be thoughtful. Intentional.
I believe the ACA has improved the lives of millions of Americans, and it's opportunities can be improved.
But even if you aren't in support of the ACA, is this the better option? Are you willing to gamble on wet spaghetti?
If the answer is no (and I hope the answer is no), here are a few resources to make your voice heard.
Text RESIST to 50409. You will be guided through a simple process that identifies your representatives and generates faxes to express your opposition to Trumpcare. It takes less than a minute.