The new boss is not the same as the old boss. Trump is not a Mitt Romney or a John McCain. His public persona is more akin to a sociopathic monster, pampered by wealth and with no stable influences around him. He will be fully enabled by a compliant Congress and is soon-to-be backed by the highest courts in the land, either all hopped up on or fearful of rising white nationalism and proud, institutional ignorance. It’s terrifying to think of the ways that can end badly.
But most worrisome is the prospect of millions losing their healthcare, and all of us losing two key restrictions the Affordable Care Act did away with: pre-existing conditions and coverage caps.
Posts like this one popped up all over the blogosphere and social media:
With Trump promising to repeal Obamacare and Republicans in control of both houses of Congress, that means the insurance companies will likely be free to reject people with pre-existing conditions again. And for me, that may as well just be a slow — or perhaps fast — death sentence. I have multiple disorders that require a good deal of medical attention, treatment and medication. There’s no way I can afford it without health insurance, nor can I afford the extraordinary premiums of being in a high-risk pool. ... I may be forced to leave the country..
Deeming your issue a pre-existing condition (PEC) means that if the insurance company unilaterally decides your medical problem existed before you enrolled in their insurance, in any form, they don’t have to cover your treatment. It also means they can charge you more and weasel out of lots of it if they do deign to cover you, a lot more (in many cases, before Obamacare, this was used to charge women more than men). Caps mean no matter how long you’ve been paying premiums, once you reach a certain level of cost to the insurance company, they will no longer cover future medical expenses. Annual caps mean no more for the rest of that contract year. Lifetime caps mean no more coverage for the rest of your life.
If you think this doesn’t affect, you might want to think again.
It’s important to understand that under the ACA, those two ugly tricks, PECs and caps, were eliminated on all healthcare plans on corporate, private, or public employees. If it is repealed entirely, word for word, those restrictions are gone and the insurance companies are free to take up right where they left off. For some already sick or injured, and many who will be injured or fall ill in the coming four years, this will indeed be a death sentence. For others, it will only mean bankruptcy and a lifetime of poverty.
There are many chronic maladies that respond well to modern medicine, but progress to tragic ends without it. Chief among these are the big three: diabetes, cancer, and heart disease. But the list of what can kill you without treatment is endless and terrifying: renal failure, every kind of congenital birth defect, multiple sclerosis, a host of autoimmune diseases, as well as thousands upon thousands of more rare ones like Huntington’s or hemophilia. That’s just disease, and doesn’t even count injuries resulting in major burns, blindness, head trauma, loss of limb, or severed spinal cords that require years of therapy just to reach the best case end result: a lifetime of disability.
In the years leading up to the ACA, insurance companies had become quite sinister in applying these restrictions. They knew full well that many rank-and-file employees in their first year on the job would not last a year without being let go while battling a life threatening condition or recovering from a serious injury. They knew that giving senior management a pass (and picking out a few tragic cases to enforce the caps out of every 50 or 100 cases) would be grudgingly tolerated by the lucky ones who didn’t get singled out. They lobbied Congress successfully to broaden the scope of those tricks and more. The ACA ended that, for all policies, regardless if they were on the ACA exchanges or not.
It is possible to repeal parts of Obamacare and leave the restrictions against caps and PECs intact. It is even possible to replace it with something similar or better. That’s what a number of older, wiser, and more compassionate indies and conservatives who voted for Trump are now busy assuring themselves will happen and what Trump himself has hinted at recently. But this was already the most conservative plan possible that could theoretically cover everyone. And they’ll soon run into the same problem everyone else does: without government-subsidized premiums and other measures like the mandate, insurance companies will have little incentive to offer plans at all. It would be like forcing them to write flood insurance for a homeowner who shows up the day before a major hurricane is about to hit.
The only way health insurance comaneis can protect against this is for deductibles and premiums to once again skyrocket for most ordinary wage earners, or withdraw from the market entirely. Private health insurance will again be unavailable, or unaffordable, for most of the middle-aged and middle-class, and completely out of reach for the working poor. Allowing more out of state competition, or for those with disposable income to sock away a little more in HSA’s, won’t change that reality one iota for the vast majority of Americans already struggling to make ends meet.
In reality, Trump has also signaled in the past that he’s onboard with the GOP promise to repeal “every word of Obamacare,” and Republicans lawmakers have painted themselves into an ideological corner over it. If they have any pangs of guilt and don’t follow through fully, they risk a very real primary challenge. Whereas a border wall will never be completed and even Trump’s handful of other specific promises would take time to get past congress or the Supreme Court, repealing the ACA can be done with two votes in both houses and a single executive signature. It’s a good bet that the ACA will therefore be repealed, and that there will be no comprehensive replacement that does the same job any time soon.
This affects me personally: I have a genetic auto-immune disease called Anklyosing spondilitis—a condition written into one’s DNA at conception cannot be more pre-existing. AS is merely one condition in a whole host of similar disorders that can cause constant, searing pain on the way to permanent disability or lingering death. They require exorbitantly expensive biologic drugs and constant visits to specialists across several fields to keep in check. But repealing the ACA affects everyone: if you stay young and healthy, forever, you will be the first. So, unless you’re a vampire ...
People live longer and better when they have the benefit of modern medicine. Take it away and they suffer more and die sooner. It’s that simple.
So yes indeed, this election will have more than consequences: this election will have casualties.