It’s disturbing that with every stroke of his pen, Trump is pulling another plank from the platform that upholds the lower-and-middle classes of this country. From hobbling workers’ rights to decimating healthcare, his and the Republican’s policies are making it tougher for people to live with dignity and be fairly paid for their hard work. So many hard-won fights over so many decades are disappearing before our eyes–workers’ rights, women’s rights, LGBT rights, minority rights, healthcare rights.
Now the Republican-majority House and Senate are proposing a new healthcare law that guts the Affordable Care Act (ACA) and threatens to leave up to 23 million without health care coverage.
Those between the ages of 50 and 64 will see premium rate increases that will force many of them to forego insurance altogether. Whereas the ACA prohibited charging older people more than three times what young people were charged, the American Health Care Act (AHCA, aka Trumpcare) will increase that difference to five times as much.
The House Republican Trumpcare plan eliminates the income-based tax credits and subsidies available under the ACA, replacing them with age-based tax credits ranging from $2,000 a year for people in their 20s to $4,000 a year for those older than 60.
The Senate plan is different in that tax credits would vary by income at a lower eligibility level than under the ACA. Sounds good, right? But the credits are smaller because their value is tied to the cost of less-generous insurance than under the ACA. What does “less generous” mean?
Currently, insurance companies are required to provide coverage for what the ACA termed, “Health Essentials.” These include:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Under the AHCA, states can waive essential health benefit requirements, allowing insurers to exclude coverage for health care products and services.
So while Republicans—and particularly Trump—are promising lower premiums, they’re also allowing the stripping away of basic services we’ve come to expect for our premiums. Take a look at that list again. Imagine not having coverage for prescriptions, laboratory services, or even hospital stays, and tell me how much “savings” one can really expect in paying for health care. The catch is, these services can be covered by health insurance companies, but for each covered service you “order,” you’ll pay dearly.
The proposed defunding of Planned Parenthood for one year will affect millions of poor women who rely on the Medicaid-reimbursed care they receive now. 97% of all services provided by Planned Parenthood include basic wellness and early intervention procedures. This, taken from their website, describes what they do to ensure women’s (and men’s) health.
- Planned Parenthood health centers focus on prevention: 80 percent of our patients receive services to prevent unintended pregnancy.
- Planned Parenthood services help prevent an estimated 560,000 unintended pregnancies in a single year.
- Planned Parenthood provides more than 295,000 Pap tests and more than 320,000 breast exams in a single year, critical services in detecting cancer.
- Planned Parenthood provides more than 4.2 million tests and treatments for sexually transmitted infections, including more than 650,000 HIV tests.
- Planned Parenthood affiliates provide educational programs and outreach to 1.5 million young people and adults in a single year.
Planned Parenthood performs abortions–that safe, legal medical procedure–for women who are not ready, or equipped, to give birth. But what is so obvious to everyone but the Republicans is that if you don’t provide contraception for those who need it most, via Medicaid or health insurance mandates, then there could be hundreds of thousands of unintended pregnancies. With states enacting draconian restrictive abortion laws, shutting down clinics, and defunding of Planned Parenthood, the most vulnerable women become the most desperate.
The proposed plan makes deep cuts to Medicaid. It ends the Medicaid expansion provided under the ACA. States will receive less federal Medicaid funding overall. The Senate bill includes deeper Medicaid cuts than the House bill.
These cuts will throw hospitals, doctors’ offices and medical facilities into a tailspin. Expect to see rural-to-mid-sized hospitals close their doors, and doctors discontinue their practices. Expect to see exorbitantly higher premiums for those who are insured, because those folks will, once again, be picking up the cost for those who will no longer be covered by Medicaid. Until the ACA, those who were insured were subsidizing those who were not. Without Medicaid, those who are insured will be doing more heavy lifting than ever.
To explain why this is so, I’ll use my personal history with insurance.
I have made a health insurance premium payment every month of my life since I got out of college. I am now 62, and fortunate to be very healthy. I have had an individual policy for almost 20 years, and I have never had a hospitalization, surgery or disease. In other words, I’m a low-end health care product user. I liked the ACA insurance mandate (gone with this Republican plan) because everyone had some skin in the game. Even if they refused to buy insurance, they had to pay a tax. As a result, for the first time ever in my life, my health insurance premium actually went down in 2017!
It was only eight dollars a month, but my premiums had increased year after year until 2017, sometimes as much as 20%. When I got the dreaded annual letter from my insurance provider, it always said, “This rate increase is not due to your use of health benefits, but the use of health benefits by those in your area.” That practice stopped with the ACA, but for decades, I had subsidized those who used the hell out of their insurance, as well as those who didn’t have insurance.
Finally, with the ACA payments that were made to health insurers by the federal government, it wasn’t up to just me and other subscribers to keep subsidizing the costs. The ACA was a relief valve, and the curve flattened. It wasn’t perfect, but it was working!
Now that will be gone, and I can’t imagine how much my premiums are going to go up between now and when I am eligible for Medicare. But they will go up for everyone, because once again we’ll be subsidizing the uninsured. My insurance provider had originally anticipated 8% increases in 2018, but when the House bill passed, it revised that to 25% increases.
And who will benefit from these massive increases imposed upon the lower-and-middle classes?
The 1%. According to the assessment was made by the Joint Committee on Taxation, a nonpartisan panel that provides research on tax issues, two of the biggest tax cuts in Republican proposals to repeal the Affordable Care Act would deliver roughly $157 billion over the coming decade to those with incomes of $1 million or more. People making $200,000 to $999,999 a year would also get sizable tax cuts. In total, the two provisions would cut taxes by about $274 billion during the coming decade, virtually all of it for people making at least $200,000, according to a separate assessment by the committee.
Repeal-and-replace is a gigantic transfer of wealth from the lowest-income Americans to the highest-income Americans.
Maybe when enough of the lowest-income Americans—many of whom voted for Trump—get huge increases in their 2018 premiums, they’ll wake up and realize that their president, their party, caused their suffering.
I just hope the Democrats ram this fact home and run on nothing but this issue during the 2018 election cycle.
How low can they go? We don’t know yet, but they are plumbing the depths of decency, and we can expect more muck to be heaped upon us as they do.