Where to begin? Ever since Thursday, I’ve spent a lot of time thinking about the passage of the American Health Care Act (AHCA) in the House of Representatives. I’ve actually spent so much time talking about what I’m thinking about that Hali encouraged me to write a post for the blog. As the parents of a child with special needs, we have a lot of concerns about what the passage of this bill means for J and for our family.
So before we dig into this, let me put my cards on the table. I’m a fairly liberal person, and in terms of healthcare, I am very much in favor of a universal healthcare system. I understand that this would be a drastic change from our current system, but the economic trends that we’ve been seeing in this country (income inequality, reduction in workers bargaining power, and rapid increases in automation) are likely going to result in exponential increases in unemployment. That means we are going to see a huge increase in the number of people that need quality healthcare that cannot afford it. Something needs to be done about the current system, but the AHCA feels like a dozen steps in the wrong direction.
That being said, I understand that discussion about healthcare and politics in general is a very volatile subject. So I will do my best to present my views using the facts that we know about the bill and what I think is a likely course for future events (assuming the bill is not drastically changed by the Senate).
Let’s start with the big issue relating to J, pre-existing conditions. The AHCA rolls back protections for people with pre-existing conditions by saying states can now allow insurance companies to charge people with pre-existing conditions higher insurance premiums. The states do have to set up high-risk pools to do this, but the higher premiums could still price people out of insurance entirely. The AARP reports that high-risk premiums could reach as high as $25,700 per year for people in the high-risk pools. In 2011, the Department of Health and Human Services estimated the number of people with these types of conditions was approximately 129 million Americans.
There’s no clear language dictating what would be considered a pre-existing condition, likely to leave that decision up to the individual states. As someone who had to navigate a maze of red tape just to get some of J’s therapy coded and funded correctly last year, I’m not very optimistic that autism or ASD would stay off of a list of pre-existing conditions. To be blunt, I don’t have faith in my state’s legislature to protect my son and my family’s interest. We live in a state that has refused to take advantage of the Medicaid expansion detailed in the original Affordable Care Act.
I don’t think it’s a huge stretch to imagine if this bill is signed into law, Nebraska would quickly take advantage of removing as many federal requirements set in the ACA as possible. J would currently be protected against this pre-existing conditions clause, as we get insurance through an employer plan. But President Trump and Congressional Republicans have repeatedly said that the AHCA is Phase 1 of their healthcare plan. Unless the future phases are just more tax cuts and defunding of ACA components, these changes could easily be applied to employer plans in the near future.
Moving past the pre-existing conditions, let’s look at the rest of the bill and its effects. I’ll have to use the Congressional Budget Office review of the bill in its original form, as the new version with its amendments was passed before the CBO review was revised (more on irresponsible governing later). The next major piece of the AHCA is the placement of sick people into high-risk pools to reduce premiums for everyone else. While this sounds fine in theory, a Washington University study found that establishing high-risk pools would save the average person $300 a year in premiums, but they would require $18 billion each year to properly fund them. The AHCA offers nowhere near this amount ($130 billion over 10 years plus an additional $8 over 5 years). That $3.4 billion per year shortcoming may not sound like much in this context, but it will mean the world to the people unlucky enough to be placed in a high-risk pool.
The AHCA also removes the federal Medicaid expansion from the ACA, and goes further to cut traditional Medicaid by $839 billion over the next 10 years. Just looking at the ACA Medicaid expansion, 10 million low-income Americans will lose the funding for their healthcare. According to the CBO analysis of the original bill, an additional 14 million Americans will no longer be insured by 2026. While some of those uninsured would be by choice (since it will no longer be required to purchase health insurance), most would be losing coverage or not have the financial ability to purchase insurance. The CBO also estimates that insurance premiums would actually increase until 2020, then decrease (based on current projections, not necessarily less than today’s averages).
So why do all of this? Tax cuts. Specifically, tax cuts for the wealthy. The AHCA includes approximately $765 billion of tax cuts over the next 10 years. The vast majority of the cuts will go to individuals earning over $200,000 per year (or couples earning more than $250,000). That’s the part that really gets me. My son’s access to affordable health insurance is being put at risk not for a misguided philosophy, nor as a side effect of a bill to help millions of other Americans, but to give money to the Republican Party’s top donors and members (and President).
This sort of reckless, irresponsible governing drives me crazy. The people elected to lead this country just forced through a bill that will harm exponentially more people than it will help. They cry foul at the Democratic Party for not casting a single vote for this bill, ignoring the fact that the bill was only worked on by Republicans who did not request any Democratic input. This bill was slapped together in 4 months, the ACA took 18 months of bipartisan deliberation and concessions. NPR reported that the AHCA had only a 17% approval rating, yet the House Republicans rushed the bill through prior to a recess instead of crafting a better bill. The President and the Speaker of the House are playing with people’s lives like this is a sporting contest, and they just wanted to score some quick points.
Now I am aware that most of the pundits, analysists, and even some Representatives say that this bill will be massively reworked in the Senate, so the major issues with this bill are not a problem. But if this is true, why pass the bill in this form at all? If the pre-existing conditions language will be removed by the Senate, why would the initial hold-outs in the House vote to approve the revised bill if they wouldn’t vote for the original AHCA? Are the people like J being treated as political ammunition just for a chance to stand in front of a podium and say “We did it”? I’m not sure how I feel about that, but I do know that it doesn’t feel good.
If you’re still with me, thank you for reading this all of the way through. Like I said, I know this is a touchy subject (obviously for me it is), but I appreciate you taking the time out of your day to let me voice my opinion. I don’t think it was made clear enough in the rest of this post, so I want to make sure that you know the way I feel about these issues is not just because I am concerned about J, but because I am concerned about everyone. I believe that no one should fear getting injured or sick for financial reasons. I don’t want anyone to feel like they can’t afford to go to the doctor, regardless of the reason. I feel that the American ideals of life, liberty, and the pursuit of happiness includes having healthcare. I don’t just care about myself, my wife, and my son. I care about your children, your grandchildren, your parents, your grandparents. I care about YOU.
I’m not sure all of the issues with national health care policy and Autism can be wrapped up in a tidy little bow. But I do know that J’s condition and treatment are always on my mind. Until this week, wondering if he’ll have health insurance was not one of those concerns. I would very much like to go back to not worrying about his health insurance so that I can focus more energy on worrying about therapy goals, summer lesson plans, and finding fun activities for him. I hope that I can realize that reality very soon.