Medicaid Expansion: The AHCA Will Yank Coverage from Millions

The people who will lose their health coverage under the American Health Care Act are not statistics or data points. The Medicaid expansion isn’t a political football to them — it’s the difference between life and death.

Each and everyone of them is a living, breathing human being. At least they are…for now. You know that. The Republicans heartlessly working to rip their care from them know that. And I know that.

I should; I’m one of them.

The people who gained healthcare through the ACA's Medicaid expansion aren't statistics...and without it their deaths will be all too real.
Preparing for my transfer to a nursing home five days before my awakening.

I shudder to think what might have happened to me under a Trumpcare/Ryancare version of Medicaid. Let’s imagine that my dermatomyositis, Legionaires’ disease, 6-week coma, and multiple strokes on both sides of my brain occurred in a future Medi-Cal — the California version of Medicaid — world.

It’s 2020 (or 2018 if the GOP wingnuts get their wish), liberal California has opted to retain its Medicaid expansion, and people who earn 138% of the poverty level can still qualify for Medi-Cal. That’s a good thing, since the US is in another recession and the jobless rate is the highest it’s been since the peak of the Great Recession.

Residents of many other states aren’t so lucky.

Still, the price tag for my hospital costs are mounting exponentially. It’s four weeks before I’m even stable enough to be moved out of the highly expensive ICU. I’m on a respirator and require dialysis. Eventually, a feeding tube is surgically implanted.

All for a “vegetable” whose odds of surviving — according to my doctors — are slim to none. And forget about me ever walking or being anywhere close to normal. They told my loved ones to give up hope that I would ever be the same again.

Meanwhile, Medi-Cal has been strained to the breaking point, as the new per capita payments — frozen at 2016 payment levels and rising only by the inaccurate medical component of the consumer price index — fails to keep up with the actual cost of care.

For weeks, the hospital bean counters have been pushing for me to be transferred– or should I say warehoused? — in a nursing home. Time after time, the move is planned, but cancelled because my condition isn’t stable enough. Indeed, in actuality, I was only moved to my first nursing home after six weeks, five days before my awakening.

I can’t say if my doctors, who had such a grim view of my prognosis, would have ever pulled the plug on me. I’m sure my loved ones would’ve sued if they had planned such an action. But perhaps the pressure from hospital administrators could’ve mounted to the point where my doctors might cave in and approve these moves before they felt I was truly ready.

My doctors pooh-poohed my loved ones reports of my improving awareness. Could I have died before they were proven right?

From a Medi-Cal administrator’s viewpoint, you can certainly see them thinking the funds keeping a basket case alive might be better served paying for maternity care. After all, births have surged since the AHCA defunded Planned Parenthood and banned tax credits used to pay for healthcare provided by a doctor of facility that performs abortions? Or health insurance that covers this legal procedure?

And California is now forced to pick up the entire tab for anyone newly added to the Medi-Cal rolls under the Obamacare expansion. This is beginning to become untenable, as the unemployment rate swells.

Let’s not forget that the ACA also forbade lifetime limits. I’ve surely exceeded all but the most generous of limits already. Trump has promised that he want to retain that provision. But without an insurance mandate, disallowing pre-existing condition exclusions and lifetime benefit limits would blow up the insurance system.

As I’ve said, you can take these promises with a Trump Tower’s worth of salt.

While I wasn’t even on Medi-Cal thanks to the Medicaid expansion, thousands of lives were saved because of it. 14 million. 24 million. 880 billion. Sums that enormous are impossible for the human mind to grasp. The only way to even get a glimpse of the enormity is to consider the unique plight of individuals.

Medicaid Expansion: Real People; Real Lives at Stake

Here are a few quotes about flesh and blood people — not walking statistics — whose lives (or their loved ones) were saved by the Medicaid expansion.

I’ve had at least one patient with colon cancer that probably would not have been diagnosed without [Medi-Cal] insurance .–Dr. Robert Shankerman, in reference to the Medicaid expansion.

I’m extremely concerned about a complete repeal of the Affordable Care Act. I fear that [Zoe] … at 6 years old, is going to have to be confronted with [the question of] ‘Why am I not being cared for anymore? Why can’t I go to the doctor if I don’t feel good?’ And not being able to protect her in that way and having her realize her own mortality because of an election is terrifying.–Stacey Lihn

I want to be here to watch my children grow up. I didn’t bring my children into this world to leave them. I want to be in their lives, to help them grow up to be respectful, to be people who get out there and earn their living, people who become ‘good American citizens.’

It comes down to one basic thing: I don’t want to die. And I especially don’t want to die because I can’t afford the healthcare that will save my life.”–Laurie Merges.

A Chimera of Chronic Maladies

On the one hand, I may be somewhat protected if whatever emerges out of the wreckage of the AHCA eventually passes both houses of congress. After all, I was awarded Medi-Cal coverage — the California version of Medicaid — prior to the Obamacare Medicaid expansion because I’m disabled. And that was before my dermatomyositis, 6-week coma, etc., etc…

In the days before the ACA, I had to fill out a disability determination form every year, proving that my lung scarring hadn’t been miraculously healed. And, yes, I still have chronic this and severe that.

Pre-existing conditions? I’ve got them up the wazoo…and including that too.

Could they revisit my eligibility determination due to dwindling funds? My application was initially turned down, but I won my appeal thanks to my numerous chronic as disabling conditions. Individually they might not have qualified me, but taken together…I’m a mess.

However, I’m fortunate enough to live in an affluent state — the eighth largest economy in the world. And the Golden State is also solid blue. Does that make it actually green?

At any rate, California was the first state to set up an ACA exchange. And with a Democratic supermajority in the state legislature and a Democratic governor, politicians would be loath to throw out the 3.7 million people added to the Medi-Cal rolls thanks to Obamacare.

I have always believed that health care is a right for everyone in California and the country. The dilemma arises on how to finance it and whether the public supports it. … The state would be unable to backfill the loss of $20 billion in federal funds without massive tax increases or major program reductions.–state senator Ed Hernandez.

Of course, I’m worried about my own healthcare. But as a liberal and a humanist, I’m also concerned about the millions of people who qualified — or eventually will — for the Medicaid expansion. Most of them aren’t “lucky” enough to be on Medicaid due to disabilities.

And, of course, I’m concerned about the burden on Medi-Cal, in my liberal state, once it’s forced to pay for the expansion itself. Denti-Cal was cancelled due to the Great Recession. As the California economy came roaring back to life, it was reinstated.

But that was before the Medicaid expansion.

Will the working poor lose out on healthcare again? Or will Medi-Cal resume shedding benefits…or beneficiaries?

Like me.


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