Newsplaining

“… They didn’t stop to think if they should” 
     There’s a quote in Jurassic Park where chaos theorist Dr. Ian Malcom says to the scientists behind the park’s attractions, “your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.”
     I hesitate to extract this metaphor and apply it elsewhere for the chance of being considered hyperbolic, but when certain circumstances arise, our best ways to make sense are to compare it to something else.
     After seven years of campaigning, rallying, complaining, voting, writing and haranguing, the GOP representatives in the house finally passed their “repeal and replacement” of the Affordable Care Act (Obamacare, ACA). The same plan that Speaker Paul Ryan told President Trump he couldn’t get enough votes for in late March, passed by a margin of 217-to-213 (the GOP needed to get to 216 for it to pass).
     Granted, the reason the former version of the American Health Care Act (AHCA) couldn’t pass the first time was because many members of the GOP Freedom Caucus called the plan “Obamacare-lite,” and moderate republicans were concerned about alienating those with pre-existing conditions in contested congressional areas. This version of AHCA contains several amendments that seemed to have consoled those members of the House, but in all actuality, many hadn’t read the bill before it came to vote, as amendments were made the night before it was voted on. And just what these amendments do presents more uncertainty due to the fact that it goes against the ideological principles of the GOP.
     The most important features of this bill are these amendments. Most notable in this bill is the MacArthur Amendment, from the representative of New Jersey, in which states now have the ability to be waived from selling insurance on the individual market place in a non-community rating model. To explain, one of the biggest policies in the ACA was community rating, in which those with pre-existing conditions could not be charged more for their insurance than a healthy person.
     Being waived from this law means that those with pre-existing conditions would be placed into a “high-risk pool,” made up of others with pre-existing conditions. Because insurers would no longer have to community rate, they could charge people with pre-existing conditions more money for insurance. While people with pre-existing conditions (those with heart disease, diabetes, etc.) do cost more in terms of amount of care needed, it’s for this reason that they actually need insurance. But, since insurers have the freedom to up-charge the pool of people who are all high-risk, they will be paying much more money, no matter age or income-level.
     Part of the amendment is providing funds to subsidize those in the high-risk pool, to bring down premiums and deductibles, to a total of $115 million, according to Vox.com. Because the nonpartisan Congressional Budget Office (CBO) has not had a chance to determine the costs of the bill, the GOP doesn’t know how much funding is actually needed to subsidize these costs, though they’ve estimated $8 billion is enough, though MacArthur has said that if there needs to be more, then they can go back and change it. This begs the question that if there is an ability to go back and change the funds in the bill, why not just wait for a CBO score and make the changes then? It seems that it is a lot harder to go back and amend a law, than to make sure you get the law right. Just look at the amount of times the GOP tried to amend and repeal the ACA. Or is it that the challenge in amending is actually the whole point, so nothing can be changed?
     Another big amendment is that states can also get waivers to not include essential health benefits in their market plans. These benefits include:
     • Outpatient care without a hospital admittance
     • Emergency services
     • Hospital admissions
     • Pregnancy, maternity and newborn care (88 percent of all insurance plans before the ACA didn’t offer maternity care)
     • Mental health and substance abuse counseling
     • Prescription Drugs
     • Rehab services (physical therapy)
     • Preventative Care (cancer screenings and physicals)
     • Pediatric care in oral and vision (children’s dentist and eye doctor visits)
     Remember, this is only in the market place, so if you have insurance with an employer, plans might not change, but if you lose your job and need new insurance elsewhere, these are some of the challenges you could face.
     According to a 2011 article published by the American Public Health Association, “more than 2 million people would have been alive during 2006 — or 780 people in a city of 100,000 — if preventive care had been widely delivered in prior years, all without an increase in net cost.”
     It’s mathematically proven that if cancer is caught in its early stages, treatment over time is much less expensive than caught in later stages. Common sense also proves that paying less than $500 to be a part of a smoking cessation program is cheaper than treating lung cancer over time.
     The fact that prescription drugs are on the chopping block on individual market plans seems like price gouging at its finest. Not only does someone need to pay more to see a doctor to find out that due to a genetic heart condition they need medication to their keep blood pressure under control, but the medication they need isn’t covered. The same can be said for diabetes medication, anti-depressants and inhalers for asthma.
     Republican Representative Mo Brooks of Alabama is quoted as saying, “[this allows insurance] companies to require people who have higher health care costs to contribute more to the insurance pool. That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy.”
     The blatant ignorance of how insurance works and for human quality of life is appalling, considering a large proportion of health conditions are caused by genetics. There are athletes that lead healthy lives, and then succumb to a genetic condition that doesn’t allow them to be athletes anymore. Is it their fault? Would we tell a high school track star to “suck it up” and pay more for medication and long-term treatment because he exercised every day? Would we tell a newborn child to get a job so that it qualifies to receives prescriptions for asthma medication?
     The joke to all of this is that right before the GOP decided to pass this bill, they exempted their own insurance plans, for themselves and their families, from any of these changes. Our representatives will never witness what will happen from this law, if it is passed in the senate.
     An $800 billion tax cut for the top 0.1 percent of Americans does not “trickle” down to someone who needs to go on Medicaid. The losers here are the old, who receive fewer subsidies due to normally high premiums, and in part to block grants of Medicaid, voiding them of fewer dollars for coverage.
     I understand that as of now, only 94 of 99 counties in Iowa have a provider on the open market. But this solution that just passed the House doesn’t make conditions any better. Not when it’s estimated that costs for seniors between 55-64 would increase by $6,971 by 2020. Not when people with pre-existing conditions (like having a heavy period, having been previously assaulted, or having had a C-section for starters) will have to pay more for insurance.
     The point of insurance is to be a subsidy pool. The low-risk payers pay for the high-risk payers. Like farming insurance, farmers pay into a pool and when tragedy strikes, they get reimbursed. The same thing with car insurance — good drivers pay for bad drivers. The point of insurance is to not use it. No one wants to pay for insurance, but they do because one day, tragedy will come for every single one of us.
     The bill must still pass through the Senate, and with an 11-day recess following the approval, it’s likely that a CBO score will be generated before the Senate can even pass it. Already, ranking member Lindsey Graham has said that the senate might need to draft a counter-bill.
     The point is that the GOP spent seven years wondering whether or not they could create a system in which 24 million people lose insurance (according to a prior CBO score), that they never thought if they should. Trump promised us everyone would be covered and costs would be lowered. That’s not what this bill is.