Fear is our most basic, lizard-brain emotion. It’s what keeps you from doing something that might win you a Darwin Award, after all. But fear is what millions of people are feeling as Congress moves with breakneck speed to push them over the healthcare cliff (or under the GOP ideological bus).
So far, I’ve written about the plight of people like me with pre-existing conditions and those in lower income brackets if Obamacare is repealed. Yet the great (if shrinking) middle class will not be untouched by the heedless rush of the Republicans to yank away the healthcare safety net finally put in place by the ACA.
My friend and colleague Dr. Jeana Jorgensen, the Foxy Folklorist, recently wrote of her own fears of losing access to healthcare. And she’s an adjunct professor currently teaching at Berkeley.
While Jeana is healthcare is covered as long as she continues to teach at Berkeley, as a professor without tenure her position is far from secure.
Indeed, Obamacare maintains subsidies for households earning $97,200 for a family of four. That’s because a major cause of low insurance rates before the ACA was crippling fees (not to mention insurance practices outlawed by its passage).
That’s right, Mitch, insurance was difficult for the middle class to afford long before Obamacare. It was harder still for the working class and virtually impossible for those whose income was just above the federal poverty level. They earned too much to qualify for Medicaid (before the ACA expansion), yet not nearly enough to pay for even bare bones policies.
Yet the wet-dream Medicaid plans of Paul Ryan will fix that inequity. If he succeeds in converting Medicaid into block grants, even those who previously qualified for Medicaid–read, me–may find themselves shut out of the healthcare system once Medicaid is starved of funds.
Furthermore, after repeal and replace, gone will be popular ACA protections such as preventing insurance companies from charging women more for the crime of having two X chromosomes.
Jeana and I are both guilty as charged.
While Jeana is fortunately healthy, I people like me would be likely to bump up against yearly and lifetime coverage limits. Indeed, if I hadn’t already been on Medicaid, I would’ve undoubtedly exceeded such limits during my six-week coma, let alone my difficult recovery.
Giving a Helping Hand to the Top of the Ladder
What’s more, the plan proposed by incoming Health and Human Services chief Tom Price would’ve eliminated income-based subsidies and replaced it with inadequate tax credits based solely on age.
Tax credits are useless for people who pay little or no taxes. Ditto for tax savings accounts.
On the other hand, Price’s plan would be a great deal if you happen to be rich and old. In other words, the Republican donor class. Not so much if you’re establishing your career and responsible–like Jeana–and understand the importance of health insurance.
Yet many healthy people will forgo health insurance until they face a health crisis or pregnancy, as they did before the ACA coverage mandates. If Trumpcare really does continue to prevent insurance companies from excluding people with pre-existing conditions, as he’s promised, that would lead to an insurance industry death spiral.
The healthy will jump ship, leaving the sick to drown in an unbalanced boat.
After Republicans stripped away mandates but continued to ban health exclusions from their sex toy, Washington, DC, insurance became almost impossible to obtain. Unless, of course, the Republicans simply allow insurance companies to charge exorbitant fees to the unhealthy. Or lump them into risk pools, which is the same thing (while offering poor coverage to boot).
Recently, it’s begun to look that cooler heads might prevail. But I don’t for a second believe it’s out of humanitarian concerns.
The middle class votes; the poor don’t.
When Trumpscare began to set in for those in the middle class, some Republicans suddenly took notice. Um, shouldn’t we have a parachute ready before we jump out of this plane?
The Donald himself has recently endorsed a version of this, saying that any delay between repeal and replace should be counted in weeks, not years. But even that might be too long. The minute subsidies are yanked, Obamacare exchanges will collapse as insurance companies trample each other on the way out the door.
It’s possible that the GOP will draw up a subterfuge that allows them to claim to have repealed the ACA while avoiding the deluge of bad press as people begin dying from lack of healthcare. And with a narrowed Republican majority in the Senate, those few relatively saner heads may be able to combine with the united Democratic opposition to delay the looming catastrophe.
Yet, though the Dems put up a valiant effort to force the Republicans into politically damaging votes against cutting Medicare (the elderly vote too) and other popular benefits like mental health coverage, the so-called vote-a-rama began the process of repealing the ACA proceeded anyway.
It now seems possible–even likely–that the more reasonable Republicans will be forced by years of demogoguery and zealotry to follow the American people over the Obamacare repeal precipice.
The fact that many of Republicans will eventually feel the wrath of the voters will be cold comfort to those buried in the wreckage they’ve wrought.
Previous posts in the Trumpscare series:
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