Trumpcare, Ryancare, Trashcare: While the GOP celebrates its found money, the poor will get sicker and die

With the AHCA, the Republicans have put a price tag on the lives of America’s working class: $300 billion

Trumpcare, Ryancare, Trashcare: While the GOP celebrates its found money, the poor will get sicker and die
(Credit: AP/Susan Walsh)

Trumpcare, Ryancare, Trashcare — whatever you want to call it, the American Health Care Act is nothing more than a cheap stab at Barack Obama, a petty attempt on the part of grudge-holding Republicans, including President Donald Trump, to try to diminish Obama’s legacy. They can try, but that will be impossible — Trump’s follow-up act has been so bad so far that he’s making George W. Bush look practically Lincoln-esque. But let’s set legacies and agendas aside for now and focus on health care.

“We have come up with a solution that’s really, really, I think, very good,” Donald Trump has said. “It’s an unbelievably complex subject. Nobody knew that health care could be so complicated.”

I’m not a president or a billionaire. I could never afford the kind of routine checkups that Trump has access to from award-winning physicians with platinum stethoscopes and solid gold scalpels — or even a state-of-the-art Viking fridge stocked with spare teenage hearts and kidneys, all plump and ready to be inserted when Trump’s conk out. He’ll probably live to be 360 years old as a result. Most of us don’t have that experience, and the president, just like the congresspeople and senators who are aimlessly playing with the lives of their constituents by threatening to kill Obamacare, is taken care of. They have amazing health care coverage that we, the taxpayers, fund. Strangely, that never makes it into the conversation.

Is Obamacare perfect? Absolutely not. But it has already saved the lives of millions of people. People who would have never voted for Obama are calling him a hero, even as some die-hard right-wingers praise the Affordable Care Act for saving their loved ones, not realizing that it’s the same as Obamacare.

Trump loves his catchphrase, “Make America great again.” Obviously he doesn’t understand that “great” is a process that we must constantly work toward. Greatness is edited, nurtured and achieved after recognizing what works and what doesn’t. Scrapping Obamacare and replacing it with a trash plan that will leave millions of people who were born without the luxury of being Trump-level rich uninsured is not making anything great. It’s evil. According to the CBO analysis, the AHCA would “reduce federal deficits by $337 billion over the coming decade and increase the number of people who are uninsured by 24 million in 2026 relative to current law.” And every Republican is running to the cable news networks, bragging about saving $300 billion. What does that mean to the person the Wall Street Journal described, a 62-year-old person who makes $18,000 a year who will now face premiums of up to $20,000?

Imagine a sickly elderly woman running home from work to her family to share with pride that the government just saved $300 billion. There is nothing more important than that to the government, even if it means that you’re broke, your granddaughter is pregnant because she couldn’t get birth control, and your grandson overdosed and died because he couldn’t be treated for his prescription drug addiction, which he developed to self-medicate his depression over the factory jobs that Trump promised never coming. We should all celebrate because the government saved $300 billion? That’s $300 billion that regular people will never touch.

People will not be treated for their illnesses. Many will suffer, and some will die. But at least the GOP beat Obama!

D. Watkins is an Editor at Large for Salon. He is also a professor at the University of Baltimore and founder of the BMORE Writers Project. Watkins is the author of the New York Times best-sellers “The Beast Side: Living  (and Dying) While Black in America” and “The Cook Up: A Crack Rock Memoir.”

Trump’s Medicaid assault: Now he’s gutting a social program he promised to protect

The White House plans to slash Medicaid funding and kick people off the program — that’s not how Trump campaigned

Trump's Medicaid assault: Now he's gutting a social program he promised to protect
(Credit: AP Photo/Pablo Martinez Monsivais)

For a long time now, Donald Trump has broadcast to the world that he is different from other Republicans when it comes to the social safety net. While most Republican candidates in the 2016 presidential race hugged the party orthodoxy that called for cuts to and restructuring of social programs, Trump positioned himself as a champion of entitlements.

“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid,” Trump tweeted a couple of months before entering the 2016 race. “The Republicans who want to cut [Social Security] & Medicaid are wrong,” he tweeted in 2015. After joining the race, Trump was similarly outspoken in his defense of government protections for the poor and the sick.

Throughout the 2016 campaign, Trump defended the idea of using government resources to provide low-income people with health care, insisting that he didn’t want to see anyone “dying in the middle of the street.” When asked how he would go about providing that assistance, Trump pointed to Medicaid. “We have to go and help them through the Medicaid system,” Trump said in September, when asked how he would provide coverage to people who can’t afford private insurance. “A lot of people said, ‘Oh, gee, that’s not the thing to say.’ I said, ‘Well you know what? If I can’t say that, I’m not running for office.’”

The casual observer might walk away from all these statements believing that Trump supports Medicaid and has no intention to do any damage to the program. But at the same time that Trump was campaigning as a Medicaid supporter, he was also pushing to fund the program through block grants, which would slash its finances and force people off the rolls. As president, Trump has continued this war on Medicaid.

Much of the violence that Trump plans to inflict on Medicaid will come through the American Health Care Act, the troubled health care reform bill that Republicans have offered as their “replacement” for the Affordable Care Act. The bill, which Trump and his administration strongly support, calls for a halt to the ACA’s expansion of Medicaid in 2020, and it would place per capita restrictions on the amount of federal funding that states can receive for their Medicaid programs.

All told, per the Congressional Budget Office, the AHCA amounts to a Medicaid funding reduction of $880 billion over the next decade. That’s a massive cut, and it would undoubtedly result in millions of low-income Americans either having their benefits slashed or being kicked off of Medicaid altogether. The budget office found that 24 million people would lose their health coverage under the AHCA by 2026, and those losses “would stem in large part from changes in Medicaid enrollment.”

Trump and his administration want to accelerate this process and worsen it. As noted above, the AHCA currently calls for an end to Obamacare’s Medicaid expansion in 2020. But the White House, in its eagerness to win conservative support for the legislation, is apparently planning to pressure Republicans in Congress to move up that date to the beginning of 2018.

This week brought still more bad news on the Medicaid front. As The Wall Street Journal reported on Wednesday, the Trump administration has communicated to governors that it “will work with states that want to alter their Medicaid programs by imposing work requirements, premiums, emergency-room copayments and other changes.” Imposing work requirements on Medicaid eligibility is an excellent way to cut people off from health coverage without doing much of anything to boost employment.

The notion that Medicaid recipients are just sponging off the government is wildly specious. According to the Kaiser Family Foundation, 63 percent of Medicaid recipients are in families with at least one full-time worker, and an additional 14 percent are in families involved with part-time work. The Center on Budget and Policy Priorities noted that Medicaid, rather than discouraging work, can actually help low-income people find jobs: “Research indicates that comprehensive Medicaid coverage can support work and help beneficiaries take advantage of promising job opportunities without worrying about losing their coverage.”

Imposing a work requirement as a barrier to eligibility, as the Trump administration wants to facilitate, makes it far more likely that unemployed people will lose access to health coverage. If those people become sick and can’t seek treatment, they’ll be less likely to find work. Providing “vulnerable populations with needed care can improve their health, help stabilize their housing or other circumstances, and ultimately improve their ability to work,” the center added.

President Trump, however, is hell-bent on hollowing out the social insurance program’s funding and making it harder for low-income people to have access to health coverage. That’s a terrible policy and a broken promise, one that runs directly contrary to how Trump sold himself to the American public.

US health care debate: A bipartisan drive to lower life expectancy

16 March 2017

The new overhaul in the US health care system that is being prepared is a highpoint in a war against the working class in the United States. The debate in Washington and the media obscures the basic motivation guiding both big business parties: to restrict access to affordable health care and sharply reduce the life expectancy of American workers.

The divisions between the Democrats and Republicans are over secondary and tactical questions. Far from “repealing and replacing” Obamacare, the Republican proposal builds on its basic framework while driving up the number of uninsured workers, making health care unaffordable for older, lower- and middle-income workers, and accelerating the destruction of Medicaid and Medicare.

The aim is to free up resources for a massive increase in military spending, while funneling even more money to the stock market and the financial aristocracy. It is a continuation of a decades-long social counterrevolution, pursued regardless which party controlled the White House and Congress.

According to the Congressional Budget Office report released Monday, 21 million Americans will lose coverage by 2020, and 24 million by 2026. How many of these people will die as a consequence?

Under the Republican House plan, a 64-year-old worker earning $26,500 will see his or her premium increase from $1,700 to $14,600 by 2026 due to the disproportionate cuts in tax credits for older consumers. A 21-year-old earning the same amount would see his or her premium drop from $1,700 to $1,450.

In so far as overall premiums drop, this is because older workers—whose health care costs are higher—will simply leave the market because they can no longer pay for insurance. The result will be a sharp increase in mortality and fall in life expectancy, which is already on the decline in the US due to the rise in suicides, drug abuse and other social ills.

These changes are only a prelude to raising the eligibility age for Medicare to 67 and beyond and transforming it into a voucher program. At the same time, the Republican plan would slash funding for Medicaid—the federal entitlement program for the poor—by 25 percent by 2026, reducing the number of Medicaid beneficiaries by 17 percent, or 14 million people. Trump’s appointee to head the Center for Medicare and Medicaid Services (CMS), Seema Verma, has already tested out work requirements for Medicaid and health savings accounts in Indiana.

When Medicare was passed in 1965, a byproduct of a powerful wave of social struggles, the average life expectancy of a male in the US was 66.8 years, and for working class men it was even lower. At the time, the government program was designed to provide a couple of years of health care. But to the growing horror of the American ruling class, increased access to health care and major advances in science and medicine led to a significant increase in life expectancy, with the government paying out benefits for a decade or two longer than had been anticipated.

The mid-1960s was also the period when many workers secured pensions and won retiree health care benefits, which enabled them to live many years after they stopped producing profits for corporate America.

This has provoked ever-greater anger and bitterness in the ruling class. By the 1990s, there was a chorus of complaints about the aging population, and how out-of-control health care costs were undermining the global competitiveness of US businesses. In 2005, Delphi CEO Steve Miller complained that “people are living longer these days.” He declared that employer-paid benefits made sense only in an era when “you worked for one employer till age 65 and then died at age 70…”

Obamacare was the first significant effort to reverse this trend by undermining the system of employer-paid health benefits and shifting the costs of medical care from the corporations and the government onto the backs of workers. The plan, drawn up by insurance and medical business interests, rationed care and dumped low-income workers into barebones plans.

In opposition to all of those who claimed Obamacare was a progressive social reform, the WSWS explained that it was the opening shot of a health care counterrevolution aimed at stripping the working class of access to affordable and decent coverage, and substantially reducing life expectancy. This assault is now being vastly expanded.

The war against the working class in the US is inseparable from the criminal wars being fought abroad. In a major article in Foreign Affairs magazine in 2016, entitled, “Preserving Primacy: A Defense Strategy for the New Administration,” House Armed Services Committee Chairman Mac Thornberry and national security strategist Andrew F. Krepinevich Jr. concluded that expanding US military operations against China, Russia, Iran and preserving US military domination would require taking on “the expanding cost of entitlement programs.” The main confrontation the next administration would have would be on “the domestic front,” they wrote.

The assault on health care, like the attack on jobs and living standards, the attack on immigrants and democratic rights, and the drive to war, will provoke enormous social opposition. The fight against Trump requires a fight against the bankrupt capitalist system and both big business parties, which laid the groundwork for the most reactionary government in US history.

This requires the building of a revolutionary leadership to unite every form of social opposition in mass political movement of the working class for a workers’ government and socialism. This is the only way that profit can be taken out of health care and high quality medical coverage established as a social right for all.

Jerry White

 

http://www.wsws.org/en/articles/2017/03/16/pers-m16.html

US ruling elite moves to repeal the 1960s


14 March 2017

The repeal of Obamacare, which began last week with the introduction of legislation drafted by Republican House Speaker Paul Ryan, working in conjunction with the Trump administration, has become the vehicle for a much wider program of social reaction.

The new legislation, which will cut off health coverage for 24 million people, will essentially put an end to Medicaid, one of the major social reforms of the 1960s, a program that has funded health care for tens of millions of poor, blind or otherwise disabled people, as well as nursing home care for the low-income elderly. It sets the stage, as Ryan has indicated, for even more sweeping legislation that will undermine and eventually destroy Medicare, which has provided health coverage for most elderly people in the United States for more than 50 years.

The major social gains of the 1960s–the last period of significant social reform in American history–are in the final stages of liquidation. This is the culmination of a protracted historical process that began almost as soon as the American ruling elite made its decision, driven by the breakdown of the post-World War II economic boom, to shift from policies of relative class compromise to ruthless class warfare. The initial steps were taken as long ago as the Democratic administration of Jimmy Carter (1977-81), which began to curb social welfare spending and targeted striking coal miners for government intervention under the Taft-Hartley Law.

The attacks were accelerated greatly under Republican Ronald Reagan, who smashed the PATCO air traffic controllers strike, giving the green light for a decade of corporate union-busting and wage-cutting, and slashed federal social spending to fuel a record military buildup. Reagan set the pace for further attacks on the programs established in the 1960s and even in the 1930s, from Clinton’s abolition of Aid to Families with Dependent Children to Bush’s targeting of aid to public education with his “No Child Left Behind” legislation, co-authored by Democrat Edward Kennedy, and the first steps towards the privatization of Medicare.

The Obama administration did not mark a reversal of this decades-long process, but rather its intensification. Obamacare was not an expansion of the welfare state, as its apologists claimed, but a reactionary effort to shift the cost of health care from employers and the government to working people. The all-out support of the Democrats for this legislation, worked out in collaboration with the insurance industry and the drug monopolies, testifies to the rightward evolution of the Democratic Party over the past 40 years.

The eight years of the Obama administration–begun with promises of “hope” and “change” and filled instead with endless war, attacks on jobs and living standards, and the steady erosion of social services such as education and health care–created the conditions for the Republican takeover of Congress and finally the victory of Donald Trump.

The ideologues of capitalism claim that the “free market” will work wonders if only the restraints placed upon its operations by past social reforms are removed. These “restraints” include every social benefit won through the struggles of the working class over more than a century. Now, every one of Great Society liberalism’s “big four,” as one historian described the laws enacted in a six-month period from April to October 1965, is targeted for destruction.

The Elementary and Secondary Act of 1965: This legislation provided the first extensive federal support for local public schools, which had become politically possible following the legal abolition of segregated public schools in the South. Funds were allocated to improve public schools in poor communities, expand libraries and take the first steps in what became known as “special education.” The law established the pre-school program Head Start as a permanent federal program.

Republican Congressman Steve King of Iowa has introduced legislation that would rescind the Elementary and Secondary Act and bar the Department of Education from funding any educational program except state-controlled vouchers that could be used for charter or religious schools or for home schooling.

Medicare and Medicaid, established through the Social Security Act of 1965: This bill for the first time provided government-backed health insurance for those over 65, half of whom had no coverage in 1965. Medicare covered hospital care (Part A) and medical and nursing fees (Part B), but did not pay for vision, dental or prescription drugs. Medicaid covered the poorest sections of working people, including children, the disabled and the blind, as well as long-term nursing home care for the poorest elderly.

The Obamacare repeal legislation would put an end to Medicaid as an entitlement program beginning in 2020, when grants to the states would be capped, forcing them to ration care to the poor and disabled. Medicare was already significantly undermined through Obamacare itself, which cut $700 billion in reimbursements over 10 years, and the repeal legislation will set the stage for even larger cuts, based on Ryan’s plan to convert the program from an entitlement to a voucher program.

The Voting Rights Act of 1965 was the most radical democratic measure enacted by a US Congress since post-Civil War Reconstruction. It targeted those states, mainly in the Deep South, where denial of the franchise to minorities was widespread. Before its passage, few blacks were allowed to register and vote in southern states from Texas to Virginia. Afterwards, voter participation among African-Americans rose sharply, as the federal Justice Department continued to oversee state electoral policies to block any efforts to discriminate.

The US Supreme Court gutted the Voting Rights Act by a 5-4 decision in 2013 in Shelby vs. Holder, ruling that the targeting of the southern states for federal intervention could no longer be justified, despite repeated renewal and extension of the law by Congress, most recently in 2006. This decision was part of a wider effort led by Republicans in state after state to enact voter ID laws and other measures whose purpose was to resurrect discriminatory practices against minority and poor voters.

The Immigration and Nationality Act of 1965, also known as the Hart-Celler Act after its leading Senate and House sponsors, abolished longstanding restrictions on immigrants from Asia, Africa and the Middle East, and ended the preference for immigrants from Northern and Western Europe over those from Southern and Eastern Europe. It also allowed unlimited immigration of family members of US citizens and residents, encouraging the growth of immigrant communities.

Trump’s travel ban on visitors from six majority Muslim countries directly violates the 1965 law, which prohibits the use of national origin as a test for restricting immigration. His executive orders on immigration as well as the proposed wall along the US-Mexico border represent an effort to turn the clock back to the period of the exclusion laws that barred Asian immigrants and the bracero program that allowed Mexican immigrants only as semi-slave labor in the fields.

There are other reforms of the 1960s, from the establishment of the National Endowment for the Arts and the National Endowment for Humanities, to the Clean Water Act and dozens of other anti-pollution laws, which led ultimately to the creation of the Environmental Protection Administration. All these are under attack by the Trump administration and the Republican Congress.

The Democratic Party has collaborated in one attack after another on the social reforms with which it was once identified. The Democrats have spearheaded the attacks on public education, introduced major cuts in Medicare funding as part of Obamacare, and did not lift a finger to restore enforcement after the Supreme Court gutted the Voting Rights Act. They oppose Trump, not in defense of social services, but on behalf of sections of Wall Street and the military-intelligence apparatus, attacking the new administration over its supposed softness towards Russia.

Even in the 1960s, Democratic Party liberalism was not a challenge to capitalism, but rather an effort, at the height of the post-World War II economic boom, to make American capitalism more palatable to the masses, and therefore safer for the capitalists, under conditions of growing mass struggles over civil rights, against the Vietnam War, and for better wages and working conditions. The measures of Lyndon Johnson’s “Great Society” were far less ambitious than the welfare states built up in Western Europe during the same period.

As historian James T. Patterson wrote of that period: “The Great Society programs were… quintessentially liberal, not radical. Except in the area of race relations–a major exception–they made no serious effort to challenge the power of established groups, including large corporations. In no way did they seriously confront socio-economic inequality or seek to redistribute wealth.”

Today, under conditions of the protracted historical decline of American capitalism, exacerbated by the impact of the 2008 financial crash and the massive transfer of wealth from working people to bail out Wall Street, no section of the American ruling class can or will defend any of the social gains of the 1960s.

The supposed Democratic resistance to Trump’s program in Congress is merely for show. The Trump administration and the Republican Party will get nearly everything they want, while the Democrats wage a phony war and call on the victims of Trump’s attacks to wait until the 2018 elections.

The Democratic Party does not represent the popular opposition to Trump and the Republicans, as congressional Democrats and political charlatans like Bernie Sanders and Elizabeth Warren claim. Rather, its function is to serve as a brake on the actual resistance to Trump, from the working class, which will take on an increasingly explosive and politically radical form.

The working class must take the lead in the struggles to defend health care, education, environmental protection, the rights of immigrants and all basic democratic rights. It must answer the capitalist program of social counterrevolution with the working class alternative of social revolution. Workers must build a mass political movement independent of and opposed to the twin parties of big business, fighting on the basis of a socialist program.

Patrick Martin

http://www.wsws.org/en/articles/2017/03/14/pers-m14.html

Gutting Obamacare: Opening Salvo in the Republican War on Seniors, Middle-Aged and Poor Americans

Seriously undermining Medicare and Medicaid, shifting thousands in unaffordable annual costs to families.

Photo Credit: http://www.speaker.gov

If Republican elites in Congress were honest about their agenda, no senior would ever vote Republican.

The current fight over repealing and replacing the Affordable Care Act (ACA) is not generally couched in terms of its impact on seniors, but it should be. It is a thinly veiled — and serious — opening attack on the economic and health security of those who have spent a lifetime contributing to our nation.

While Donald Trump and his fellow Republicans campaigned on undoing the Affordable Care Act, no one ran on undermining Medicare or Medicaid. No one ran on undermining the health security of seniors. But the so-called repeal and replacement of the ACA would do just that.

Let’s start with Medicare. Seniors aged 65 and over, as well as people with serious disabilities, rely on Medicare for their basic health insurance. That program will be seriously weakened if the Republican plan to gut the ACA is enacted. It is estimated that Medicare’s revenue will drop by $346 billion. The Republican bill to repeal the ACA drains Medicare to gives tax breaks to wealthy Americans and corporations. In fact, even before Republicans pass a so-called “tax reform bill,” this bill’s giveaway amounts to a whopping $525 billion tax break for the wealthiest among us.

For those who have been paying attention, this weakening of Medicare is not surprising. In fact, it is just the first step in the eventual dismantling of this vital program, which Speaker Paul Ryan has been advocating for years. Consistent with that goal, as soon as the election ended, Ryan announced his intention to voucherize Medicare. He falsely claimed that Republicans had to “address” Medicare, saying, “because of Obamacare, Medicare is going broke.”

That is an enormous lie. The ACA strengthened Medicare’s finances. It is the Republican bill that would weaken Medicare. The next step will be undoing Medicare, by replacing its guaranteed insurance with vouchers. In that way, Republicans will shift Medicare’s costs from the government balance sheet to the shoulders of seniors, who will be on their own.

Medicaid is another program vital to seniors and people with disabilities. The Center for Medicare and Medicaid Services has found that at least 70 percent of seniors will need long-term care at some point. Medicaid currently pays for the long-term care of more than 60 percent of nursing home residents.

The GOP’s bill, if enacted, will place caps on Medicaid spending, again shifting costs away from the federal balance sheet and to the balance sheets of states and individuals. If that is enacted, seniors needing long term care and their families may find themselves out of luck, since nursing home care is extremely expensive. It is estimated that the typical annual cost of a semi-private room in a nursing home is $80,300. Very few families can afford that huge cost on their own.

And the impact on seniors not yet 65, and so, not yet on Medicare, will be the harshest of all. They will have more difficulty obtaining insurance and will face higher health care costs if this legislation is enacted and implemented.

(Editor's note: As Vox reported in its Tuesday analysis, "In general, the impact of the Republican bill would be particularly severe for older individuals, ages 55 to 64. Their costs [of annual premiums] would increase by $5,269 if the bill went into effect today and by $6,971 in 2020. Individuals with income below 250 percent of the federal poverty line would see their costs increase by $2,945 today and by $4,061 in 2020.")

In addition to slowing the cost of health care generally, the Affordable Care Act (ACA) limited the amount that insurance companies could charge seniors for healthcare. Upon repeal, insurance companies will be free to implement the ageist policy that charges even healthy seniors five times more for no reason other than their age. Not only that, the bill reduces what services insurance is required to cover. The result: people will be paying far more money for much worse coverage. This will be devastating for people in their fifties and early sixties, who aren’t yet eligible for Medicare.

The truth is that all of these cuts are entirely unnecessary. In fact, Medicare should be expanded to cover all of us. Medicare and Medicaid are more efficient than private insurance. Other nations are able to provide health care as a right, at a fraction of the cost with better health outcomes. We should be building on the successes of Medicare and Medicaid and the cost savings measures of the ACA. But instead, Republicans in Congress want to take us backwards.

Their reasons? Ideology, power, and greed. By proving that government can play a positive role in people’s lives, and provide wage and health insurance better and more efficiently than the private sector, Medicare and Medicaid, together with Social Security, disprove the GOP’s radical anti-government philosophy. Who would benefit from a nation without Social Security, Medicare, Medicaid, or the ACA? Wealthy donors.

While the top one percent has most of the nation’s wealth, we still are a nation of one person, one vote. Seniors and their families have the numbers to defeat this attack. But it will demand that all of us make our voices heard.

 

Nancy Altman is author of The Battle for Social Security: From FDR's Vision to Bush's Gamble (John Wiley & Sons, 2005) is president of Social Security Works and Chair of the Strengthen Social Security Coalition. She is co-author, with Eric R. Kingson, of Social Security Works! Why Social Security Isn't Going Broke and How Expanding It Will Help Us All (The New Press, 2015), and has written the forward to a new release of Thomas Paine's

http://www.alternet.org/economy/gutting-obamacare-opening-salvo-republican-war-seniors-middle-aged-and-poor-americans?akid=15273.265072.9VWtB6&rd=1&src=newsletter1073462&t=24

6 Diseases That Could Skyrocket or Become Far More Deadly If the Affordable Care Act Is Repealed

PERSONAL HEALTH
Bernie Sanders may have been underestimating when he said 36,000 per year will die if the health care law is dashed.

Photo Credit: Shutterstock.com

When senators Bernie Sanders and Ted Cruz debated the merits of the Affordable Care Act of 2010, aka Obamacare, on February 7, Sanders had a dire prediction: “We are moving into an era where millions of people who develop terrible illnesses will not be able to get insurance, and God only knows how many of them will die.” The Vermont senator, who favors a single payer or “Medicare for all” system, was right to be concerned. It remains to be seen when or how Republicans in the U.S. Senate and the House of Representatives will repeal the ACA; Sen. Rand Paul has been complaining that repeal is taking much too long and that fellow Republicans don’t appear to be in a hurry to repeal it. But the Urban Institute estimates that if and when Republicans do repeal the ACA, “The number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people”—and Sanders has predicted that “36,000 people will die yearly as a result.”

Sanders is not exaggerating about the potential death toll; if anything, he is being optimistic. In 2009, a pre-ACA Harvard Medical School/Cambridge Health Alliance study found that almost 45,000 Americans were dying annually due to lack of health insurance. Shortcomings and all, the ACA—according to Gallup—has reduced the number of uninsured Americans aged 18-64 from 18% in 2013 to 11.9% in late 2015. And that includes millions of Americans with pre-existing conditions such as diabetes, heart disease and asthma. The ACA has not only made it illegal for insurance companies to exclude people due to pre-existing conditions, but it has also emphasized preventive care and screenings, which can prevent chronic conditions from developing or at least treat them after a diagnosis. Without those protections, it stands to reason that diabetes, heart disease, cancer and other potentially life-threatening illnesses will be on the rise.

Here are several diseases that are likely to increase or have much worse outcomes if Republicans succeed in abolishing Obamacare and render millions of Americans uninsured.

1. Diabetes

According to the American Diabetes Association, 30 million Americans suffer from diabetes, while another 86 million have prediabetes. For those 116 million Americans, access to health care is crucial; diabetes, if not managed and controlled, can lead to everything from amputations to heart disease, stroke and blindness. And when prediabetes is managed, patients have a much better chance of avoiding full-blown diabetes. Bearing those things in mind, the American Diabetes Association sent members of Congress a letter in December warning them how dire the consequences could be for Americans with diabetes or prediabetes if the ACA is repealed without a suitable replacement.

“The ACA,” the American Diabetes Association told Congress in the letter, “ended fundamental inequities in access to adequate and affordable health insurance that separated Americans with diabetes from the tools they needed in the fight against the horrific and costly complications of diabetes, including blindness, amputation, kidney failure, heart disease, stroke and death. Repealing the ACA will create huge access barriers for millions of Americans, especially if no fully defined replacement is put in place immediately to meet the health care needs of individuals with chronic health conditions like diabetes.”

In 2016, medical researchers Rebecca Myerson and Neda Laiteerapong examined the ACA’s possible effects on diagnosis and treatment of Type 2 diabetes. The physicians found that 23% of American adults, aged 18-64, with diabetes lacked health insurance in 2009/2010, but said it was “likely that a significant fraction became insured in the subsequent years due to ACA provisions.”

2. HIV/AIDS

Jennifer Kates, director of HIV policy for the Kaiser Family Foundation, has described the ACA as a “watershed moment” for Americans living with HIV, and the Centers for Disease Control called it “one of the most important pieces of legislation in the fight against HIV/AIDS in our history.” Kaiser research has indicated that 200,000 HIV-positive Americans may have gained coverage through the ACA, and according to the AIDS Foundation of Chicago, the ACA brought insurance to 12,000 HIV-positive Illinois residents.

With HIV treatment, one of the goals is avoiding full-blown AIDS. In a recent article for The Advocate, Carl Schmid, deputy executive director of the AIDS Institute, warned that ACA repeal could be devastating for Americans living with HIV and that access to treatment can be a matter of survival.

“If Congress repeals the ACA without simultaneously replacing it with programs that ensure comprehensive health coverage for the same, if not more, individuals, the private insurance market will become unstable—and people with HIV and others would lose access to the care and treatment that they rely on to remain healthy,” Schmid said. “People with HIV, who depend on a daily drug regimen, cannot risk losing access to their health coverage—not even for a single day… We cannot afford to go backwards by eliminating or destabilizing the health care that the ACA provides.”

3. Cancer

In January, Gregory Cooper and his colleagues at University Hospitals’ Cleveland Medical Center in Ohio released a study that compared access to cancer screenings before and after the ACA, which they found was making it easier to obtain mammograms but needed to do more to encourage colonoscopies. Cooper, reflecting on GOP plans to repeal the ACA, stressed that the U.S. needs more cancer screening, not less, saying, “If you take away people’s health insurance and they’re going to pay out of pocket for health care, are they going to get a mammogram, or are they going to buy food? People are going to do what gives them the best benefit in the short term, which is food and shelter.”

Amino, Inc., researching 129 insurance companies, has offered some estimates on possible out-of-pocket costs for cancer screening in a post-ACA environment; in Alaska, for example, the costs could be almost $500 for a routine mammogram or $2,565 for a colonoscopy. And as Cooper pointed out, Americans will put off or avoid potentially life-saving tests when they become cost-prohibitive.

4.  Blood Pressure and Hypertension

In 2015, researchers at George Washington University School of Public Health released a study on the effect the ACA was having on hypertension, a major factor in heart disease and stroke. The researchers reported that 78 million Americans suffer from hypertension and that “lack of insurance coverage is a critical barrier to better treatment of hypertension,” and they predicted that if ACA expansion continued, it “would lead to a 5.1% increase in the treatment rate among hypertensive patients.”

5. High Cholesterol

In 2015, the Harvard T.H. Chan School of Public Health published a study that linked the ACA with better outcomes for three conditions: diabetes, high cholesterol and high blood pressure. The study found that uninsured people suffering from any of those conditions were much less likely to find out they had a problem, whereas insured people had a 14% greater chance of finding out if they had diabetes or high cholesterol and a 9% greater chance of finding out they had high blood pressure. And for those who those who were diagnosed, the Chan School found, being insured greatly improved one’s chances of controlling blood sugar, total cholesterol or systolic blood pressure.

Joshua Saloman, a senior author of the study, said, “These effects constitute a major positive outcome from the ACA. Our study suggests that insurance expansion is likely to have a large and meaningful effect on diagnosis and management of some of the most chronic illnesses affecting the U.S. population.”

But instead of insurance expansion, Republicans could significantly reduce coverage. Even John Kasich, right-wing governor of Ohio and one of the many Republicans who lost to Donald Trump in the 2016 GOP presidential primary, sounded a lot like a Democrat when he said that while there is “room for improvement” with the ACA, he was worried about what would happen to “these people who have very high cholesterol” if it is repealed without a solid replacement.

6. Asthma

Before the ACA, the term “pre-existing condition” as defined by health insurance companies was far-reaching; anything from multiple scleroses to kidney disease to anemia was grounds for rejecting an application for coverage. For people with asthma, obtaining health insurance was difficult or impossible. 17.7 million adults, according to the Centers for Disease Control, suffer from asthma in the U.S., and when asthma is not treated or controlled, it can become life-threatening (in 2014, CDC attributed more than 3600 deaths annually in the U.S. to asthma).

In 2013, a Harvard Medical School study cited lack of health insurance as the main reason asthma care for young adults deteriorated when they turned 18; emergency room visits became more frequent, and medications often became cost-prohibitive. But with the ACA’s implementation, young asthmatics could stay on their parents’ health plans until 26—and asthmatics, regardless of age, could not legally be refused coverage because of their condition. With full ACA repeal, however, it could once again become legal for insurance companies to deny coverage to asthmatics. And even partial ACA repeal could make asthma care cost-prohibitive.

While ACA repeal is likely, it remains to be seen what, if anything, Republicans would replace it with. Rep. Steve King has made it clear he couldn’t care less if the ACA is repealed without a replacement. However, Rep. Tom Price, President Trump’s nominee for secretary of the U.S. Health and Human Services Department, has proposed replacing it with a plan that would eliminate Medicaid expansion, thus making coverage more expensive for Americans with preexisting conditions. And President Trump has promised that after the ACA, Americans can look forward to more comprehensive coverage at much lower prices. But it’s an empty promise because he has yet to offer any specifics.

In other words, Republican plans for an ACA alternative range from terrible to woefully inadequate to nonexistent. To make matters worse, Rep. Paul Ryan is still pushing for Medicare privatization, meaning that Americans who suffer from ACA repeal could be facing additional hardships if they live to see 65. With Republicans going out of their way to make access to health care difficult or impossible for millions of Americans, the future looks grim for anyone suffering from cancer, HIV, hypertension or other potentially deadly illness.

Alex Henderson’s work has appeared in the L.A. Weekly, Billboard, Spin, Creem, the Pasadena Weekly and many other publications. Follow him on Twitter @alexvhenderson.

http://www.alternet.org/personal-health/6-diseases-could-skyrocket-or-become-far-more-deadly-if-affordable-care-act-repealed?akid=15228.265072.2xuNye&rd=1&src=newsletter1072659&t=4

Republican health care plan guts Medicaid, shifts funds from poor to rich

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By Kate Randall
18 February 2017

House Republican leaders on Thursday briefed rank-and-file members on the outlines of their plan to replace the Affordable Care Act (ACA). Speaker Paul Ryan, Health and Human Services Secretary Tom Price and two House committee chairmen reported to the press on the “talking points” presented at a meeting in the House basement.

Though short in details on how the proposals would be paid for, the plan takes aim at Medicaid, the government health care program for the poor and disabled jointly administered by the federal government and the states. It would also shift the burden of health care costs even more heavily on the working class. Republican leaders provided no estimates of the number of people who might gain or lose insurance under their proposals.

Donald Trump met at the White House Thursday with House Republicans who backed his presidential bid who were looking for his support in repealing and replacing the 2010 legislation commonly known as Obamacare. At a news conference following the meeting, the president said, “We should be submitting the initial plan in March, early March,” appearing to refer to a House bill that could move forward by then.

From its inception, the ACA’s aim has been to cut costs for corporations and the government, while shifting the US to an even more heavily class-based health care system than what previously existed. Obamacare’s key component, the “individual mandate,” compelled those without insurance to purchase it from private insurance companies under threat of a tax penalty.

Outlines of the Republicans’ replacement plan would further boost health insurers’ profits. The ACA’s modest government subsidies to low and middle income people would be replaced with tax and other mechanisms that would favor the wealthy and provide little to no assistance to the vast majority of health care consumers.

The Republican plan would repeal the individual mandate and penalty, but it would also eliminate fines on employers for not providing their workers with insurance coverage. Sources familiar with the proposal told the AP that a new tax might be imposed on individuals receiving health care from their employers valued above $12,000 for an individual or $30,000 for families. That is, it would penalize those receiving decent employer-sponsored health insurance.

It would also roll back the Medicaid expansion under the ACA, which has newly insured an estimated 10 million people. Republicans have long eyed the program—which provides vital health coverage to families, seniors and people with disabilities—for destruction. This attack on Medicaid would go a long way toward this aim, and it is among the most vicious of the Republicans’ proposals.

While providing no dollar amounts or details, the House outline calls for converting Medicaid to either a per capita cap or a block grant to the states. All past Republican plans, including those of Ryan and Price, have featured deep cuts that would grow steeply over time. It would be impossible for states to absorb these cuts without cutting coverage for people who should qualify for benefits.

Currently, Medicaid funding adjusts to meet need, whether from a public health emergency like the opioid crisis or the Zika virus, or the growing health care needs of aging baby-boomers. A block grant or per capita cap would deliberately stop this automatic response to increased need, forcing states to decide who should be denied benefits, or how benefits should be rationed among the most needy.

The Republicans’ “talking points” also confirm that “Obamacare’s Medicaid expansion for able-bodied adults [sic] enrollees would be repealed in its current form.” Their proposal would end the ACA’s enhanced federal matching funds for the currently enrolled Medicaid expansion population after a limited period of time.

While states would be “free” to continue to cover the 10 million people, plus those who would become eligible in the future, under Obamacare’s Medicaid expansion, by a set date they would have to pay between 2.5 and 5 times as much per person to do so, according to the Center on Budget and Policy Priorities (CBPP). The massive cut in federal funding would force states to choose between covering low-income adults and covering children, seniors and the disabled.

The savings from the cuts to Medicaid would likely go toward “relief from all the Obamacare tax increases,” as outlined by the House Republicans. According to CBPP, based on previous plans, these savings would “go to help fill the hole created by cutting Medicare taxes for high earners and eliminating drug company, insurer, and other fees” that helped finance Obamacare’s coverage expansion.

The resulting tax cuts would average $50,000 per year for households with incomes over $1 million, according the Urban-Brookings Tax Policy Center.

In place of the ACA’s refundable premium tax credits (subsidies) that are currently helping more than 9 million people afford coverage, the Republican proposal would offer a flat credit determined by age, regardless of income, with the biggest financial benefits going to older Americans.

This would mean that a 25-year-old earning $25,000 a year would receive less of a tax credit than a 65-year-old multimillionaire. The end result would be that many low- and middle-income people would be unable to come up with the money to pay the gap between their fixed tax credit and the cost of a health insurance plan.

The Republican proposals would also expand Health Savings Accounts (HSAs), which allow people to put aside money tax-free to pay for out-of-pocket health care expenses. These HSAs are obviously of little help to families struggling to pay rent, utilities and put food on the table and have nothing to set aside. The tax benefits for the wealthy, on the other hand, would be substantial.

The House Republicans’ plan calls for the creation of unspecified “State Innovation Grants” to supposedly aid states in covering costs for diversifying the risk pool and covering people with pre-existing conditions. CBPP notes that previous “high risk pools” have failed to provide affordable, quality health coverage for sicker individuals.

 

WSWS