Healthcare + Politics: What If?

By Richard Gingery, M. D.

Imagine the following scenario should the Republican-controlled Congress finally be successful in repealing and replacing the Affordable Care Act with their current plan.  It is December, 2017, and the year's first heavy snow fall put you to work.  You shoveled snow until a nagging pain in your chest made you stop.  With a few minutes of rest, the pain went away.  At this point it does you no good to know that if you were Canadian or French or British or Dutch or Swedish or a citizen of any other developed country you could callfor help or go to the hospital to find out what was causing the pain without having to worry about a medical deduction or a co-pay you could not afford or a medical plan that did not cover your situation.  You would not have to worry about providers who were “not in your network.”  You would not have to deal with a multi-tiered system in which you could not be guaranteed that you could find a provider who accepted your Medicare or Medicaid.  You would not be treated with unaffordable prescriptions.  But the new “American Health Care Plan” has reintroduced high deductibles, high co-pays, insurance plans that no longer offer all the “ten essential benefits, and providers who are once more squeezed by Medicaid programs that no longer cover the providers' costs.  

In this situation your options are few and discouraging.  If you are rich, or if you are old enough to be on Medicare and have a good supplemental insurance, you can go to a medical provider or hospital knowing that when you walk out the door, you will have been treated appropriately and you finances have been left intact.  If you are poor enough that you are still covered by Medicaid (as the Republican plan would alter Medicaid by offering Medicaid “block grants” to the states, only those who qualified for Medicaid before the enactment of the Affordable Care Act may have some assurance of holding on to that coverage), you can only hope your provider takes Medicaid.  For the millions of Americans too “wealthy” for Medicaid but too young for Medicare, the American Health Care Plan would maintain many of the benefits of the Affordable Care Act—if you are healthy and with one additional caveat.  While the Republicans in Congress want to be seen as supporting your health care needs, they are writing into their health care law a proviso that allows individual states to back out of any part of the health care legislation the state doesn't like.  Those “essential benefits” insurance companies must provide now under the ACA are likely to remain in place in blue states, but the benefits may go away in a number of red states.  

Further, if you are sick or have a pre-existing condition, you may find yourself in a state “high risk” pool in which your premiums may increase many-fold so the healthy won't have to pay quite so much for their insurance.  In this new world there is no longer a mandate to buy insurance.  You can go without, but bear in mind that in every year one person in eleven hundred with no insurance will die from a treatable cause simply because he or she has no insurance according to a study done by the Harvard School of Public Health..  The other too real risk of dropping insurance is bankruptcy and financial ruin.  

To put this last point in a little different light, under the Republican health care plan 14 million Americans who are currently insured under the ACA wind up uninsured in the first year.  More than 12,000 of those uninsured individuals will die in that first year, and the death toll will only rise as the number of uninsured climbs toward 24 million a decade or so down the road as predicted by the Congressional Budget Office.  One wonders, given a death toll in the first year that is four times the death toll of 9/11, if the Republican Congress should not be required to register as a terrorist organization!