ACA Repeal and Replace- Part 5 Gajillion

(Cassidy and Graham–Getty Images)

Congress has one last attempt in them to repeal the Affordable Care Act and replace it with something that will cause millions of Americans to lose insurance. It’s called the Cassidy-Graham Plan….just kidding! Lindsey Graham would never let anyone else put his or her name first. It’s called the Graham-Cassidy plan, and here’s how it “works”. As you can see, much of the plan can be summed up by saying that Federal subsidies for healthcare would be transferred to the states, which can then do what they wish with that money. It’s a States’ Rights approach…I guess. But in practice, it will mean that many Americans will lose healthcare. Why?

Reason One: By removing the Medicaid Expansion and leaving this up to the states, those states that are unable to make up the difference will need to decide whether to cut funding to certain people or find a way to come up with it. That could mean increased taxes, but that seems unlikely. Cutting people out of Medicaid is more likely. I’m not saying that out of pure cynicism. I have personally witnessed several people here in Ohio go through the process of trying to receive disability. The first application is automatically denied; you then go through an appeals process, which can take 6 months to a year. You are then VERY likely to be denied again, at which point you get another appeal. After a year and a half to two years (longer in some cases), you will finally get your verdict. States will do everything they can to deny you, but if you are lucky enough to receive the funding, after two years of waiting, you will need to continuously prove that you still deserve it. That’s under the current system. With less funding, things will be even harder.

Reason Two: The distribution of funds will be up to the states, which will allow them to decide who is eligible and who is not. In practice, this means eliminating pre-existing condition protection as well as federal guidelines for mental health, disabilities, etc. Some states do not recognize certain mental illnesses or disabilities as legitimate. People with those disabilities are very unlikely to have the money to move to another state. They will simply be left behind.

Reason Three: In fact, under this plan, states will be allowed to deny mental illness coverage altogether. There are several provisions of the ACA that specifically define mental illnesses, and even include issues like drug addiction. Under the new plan, the states could ignore those definitions, which in practice will mean that many of the people who now have coverage for mental illnesses will lose that coverage.

This leads me to the main issue that I want to raise here. Graham and Cassidy have defended the bill by stating that it does not remove the pre-conditions clause of the ACA. In other words, insurers will not be able to deny people with pre-existing conditions. When NPR suggested that in fact it would harm people with pre-existing conditions, Cassidy tweeted that this was false (FALSE!). People with pre-existing conditions would still have access to healthcare.

Here is the key point. Whenever you see the word ‘access’ you should recognize that you are being intentionally misled. Yes, intentionally. ‘Access’ is a buzzword among people who want to take something away from others, but don’t want to be caught doing so. In this case, Cassidy is right that the bill will not remove access to healthcare. In other words, insurers will not be able to deny people insurance simply because those people have a condition.

What is misleading here is that ‘access’ refers to a negative liberty that protects us from government interference in our choices. In other words, we will all be allowed to purchase insurance, regardless of existing conditions. However, there will be no controls on how much insurers may charge us for that access. This is a bit like saying that I have access to a yacht. No one is preventing me from purchasing a yacht. Of course, I don’t have the money to buy one; so that access is moot.

We all have access to healthcare at all times—if we can afford to pay for it. We don’t even need insurance. We can just purchase any procedures we need. Realistically, of course, that means nothing. Most people cannot afford the exorbitant costs associated with even minor surgeries, assuming we can even find out in advance how much it will be.

Graham and Cassidy know this. They know that removing government subsidies to offset insurance costs will effectively prevent people with pre-existing conditions from being able to afford the premiums of insurance plans that are unregulated.

Here’s one calculation of what that would mean, based on existing data.  Doctors have spoken out against the bill as well. Let me stress one important part of that last article. Some people, including some legislators, seem to think that healthcare is an individual rights issue, because purchasing it is like purchasing a car for yourself. It isn’t. Having a healthy society benefits all of us, as individuals and as a community. It’s not something we can choose to buy or not buy. When you need it, you must have it. There are no alternatives. There’s no public transportation option, like there is for cars. You can’t carpool on healthcare. Most importantly, you will use our healthcare system. If Republicans are so worried about the free rider problem, they would do well to keep that in mind.

Everyone will use healthcare at some point in life; most likely multiple points. This is as much of a social need as having a police force or fire departments or roads. In fact, it’s more important than all of those things. It’s literally life and death, and unlike the fire department, we will all need to use it.

It’s time to stop messing around with this issue and catch up to the rest of the world, which realized decades ago that a public system of healthcare is a basic right in today’s world, a positive right that should be provided in some way by the government.

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