The battle over health care is literally a life and death struggle. In a piece in the Washington Post, doctors David Himmelstein and Steffie Woolhandler concluded that a repeal of Obamacare (Affordable Care Act or ACA) will result in an estimated 43,956 deaths each year, even by the most conservative estimates. Himmelstein and Woolhandler are distinguished professors at the City University of New York School of Public Health and visiting professors at Harvard Medical School.
They say: “The biggest and most definitive study of what happens to death rates when Medicaid coverage is expanded, published in the New England Journal of Medicine, found that for every 455 people who gained coverage across several states, one life was saved per year. Applying that figure to even a conservative estimate of 20 million losing coverage in the event of an ACA repeal yields an estimate of 43,956 deaths annually.”
That’s just people who are on Medicaid. Trump’s American Health Care Act (AHCA) will also harm Americans who receive health insurance through their employer. The new bill, which passed the House, would allow each state to set its own rules for deciding which health benefits are “essential” to providing good coverage. Employers who conduct business in more than one state would be allowed to pick and choose which state’s rules to follow. There are provisions in the law that would outlaw giving any federal funds to Planned Parenthood and similar medical facilities.
Obamacare prohibited insurers from banning people with “pre-existing conditions” and from charging them more. Under Trumpcare, states could once again charge higher premiums to those people. They would be shoved into “high-risk pools,” which “historically had very low coverage, waiting lists, poorer coverage and high costs,” according to Dr. Atul Gwande, surgeon and public health researcher. People in those pools could pay premiums as high as $25,700 a year, according to a report from AARP.
Obamacare imposed some remarkably progressive taxes on the rich to fund Medicaid expansion and insurance exchange subsidies. Many liberals didn’t notice this development but conservatives were enraged. Trumpcare is their revenge. Benjamin Sommers, a professor of health policy and economics at Harvard’s School of Public Health, gives the grim details:
“The AHCA repeals hundreds of billions of dollars in taxes on high-income households and insurance companies, while reducing the Obamacare tax credits that helped lower and middle income families purchase health insurance. The changes to Medicaid are even more dramatic, with more than $800 billion dollars in federal money for the program cut over the next decade — this will have a huge impact on the 70 million lower-income children, adults, disabled individuals and elderly who currently rely on Medicaid for their health care.
“Add in the termination of the taxes of investment income and the higher tax obligations in general of more affluent individuals and the AHCA would lead to a dramatic shift of resources away from the poor, working class and lower middle class, especially for people with jobs outside of the realm of large employers.”
Trumpcare provides a tax cut to the rich, equivalent to $650 billion over 10 years. Over 24 million people would lose their health insurance, according to the Congressional Budget Office. Medicaid will be turned into federal “block grants,” which will allow states to reduce benefits and remove people from Medicaid. The Medicare trust fund will be drained of income by ending Obamacare’s surtax on the wealthy.
The Republicans say they want to repeal and replace Obamacare by creating something that lowers costs and covers everyone. If the Republicans are serious, they would consider a program like Medicare to be a solution, not a problem.
Consider that Medicare covers the people with the highest healthcare costs, including 46.3 million seniors and 9 million Americans with serious disabilities. Yet in 2015, Medicare’s administrative expenses were just 1.4 percent of all of the program’s expenditures. By contrast, private insurers’ combined administrative expenses and profits consumed 20 percent of customers’ premium payments.
Policy analyst Nancy Altman says that President Lyndon Johnson wanted Medicare to eventually cover all of the American people: “LBJ started with Medicare, expecting Medikids to follow shortly. After that, it would be simply a matter of closing the gap in ages. The initial age of eligibility for Medicare could be gradually lowered from age 65. And the age at which children no longer were covered by Medikids could be gradually increased. And voila! Meet in the middle and we have Medicare-For-All.”
Unfortunately, that didn’t happen. But today Medicare-For-All (or single payer) has suddenly become increasingly popular. A majority of House Democrats are now co-sponsors of HR 676, a Medicare-For-All bill introduced by Rep. John Conyers Jr., a Democrat from Michigan. Several progressive organizations are promoting it. However, with a far-right Republican Party controlling the presidency and both houses of Congress, the bill won’t be passed for awhile.
In the short-term, we can’t go backward. We have to defeat Trumpcare.
This opinion column does not necessarily reflect the views of Boulder Weekly.