Painfully “Beautiful”

The Trump administration has instructed his Attorney General to support a lawsuit brought by 20 red state attorneys general to uphold a Texas federal court ruling that the Affordable Care Act (ACA or Obamacare) is unconstitutional because its principal financing structure was deleted by Congress. Trump said that once the ACA is killed – even as such a ruling would leave millions of Americans without healthcare insurance – he and his Republican Congress would replace it with a “beautiful” and affordable alternative. 

There are so many catches. Even assuming the Supreme Court agrees with some pretty wild stretches of legal interpretation and kills the ACA, it would take a dysfunctional Congress years to pass a replacement. And that would also presume that the GOP has a replacement bill waiting in the wings… which it does not. There are powerful Congressional Republicans who think the government should get entirely out of the social service arena; they’re not even happy with Medicare. Even imagining a GOP healthcare bill that really works for those who have coverage under the ACA is a stretch.

Indeed, the red state/Trump administration cabal have twisted and turned to erode as much of the ACA as possible. Defunding. Attempting to grant exemptions from the rules – almost always rejected by the court – to allow, directly or indirectly, policies that have dollar caps and exclusions (or “non-coverage”) for preexisting conditions. The net impact of these machinations has been to cause premiums, co-pays and deductibles to soar… which the GOP then touts as proof that the ACA does not work. Hmmm. A little bootstrapping.

No one can tell you that the ACA is perfect. The pharmaceutical industry got to charge full freight for its products in exchange for supporting passage back in 2010. There are problems everywhere, but the ACA was working. Most of the issues stem from GOP attacks and erosion. Most seminal social legislation is amended many times before stabilizing. The ACA really has been left, without meaningful amendment, to twist in the wind. Gridlocked Congress won’t even try to fix it. The GOP is offering nothing tangible as an alternative and probably never will.

But soaring healthcare costs, even for those with insurance, has been the inevitable result of this conservative push against universal healthcare… even extending into the world of private insurance. Writing for the June 11th Los Angeles Times, Noam Levey explains the pain: “The steep rise in health insurance deductibles over the last decade has saddled insured, middle- and working-class Americans with medical bills they can’t afford, a Times examination of job-based insurance shows.

The biggest impact, however, has been on people like Matney who have illnesses such as diabetes, cancer and epilepsy that require regular medications and consistent care.

“As drug prices have skyrocketed and deductibles in job-based coverage have more than tripled in the last 12 years, soaring to an annual average of $1,350, these sick Americans now routinely pay thousands of dollars every year to get care they need. That has made being sick in the U.S. dramatically more expensive.

“‘It’s really a double whammy,’ said Dr. Brian Callaghan, a University of Michigan neurologist who has studied the impact on people with neurological illnesses… The financial strain is pushing millions of seriously ill Americans to ration their care, jeopardizing their health and even their lives.

“In 2016, for example, Americans taking multiple sclerosis medications every month paid on average $3,708 a year out of pocket for the drugs. Patients in high-deductible health plans paid even more, with average annual costs of nearly $8,000, according to a study by Callaghan… Fifteen years earlier, the out-of-pocket costs for those medications were $244 on average, adjusted for inflation.

“The average patient with lymphoma, a common blood cancer, pays nearly $3,700 in the 12 months following the diagnosis, according to an analysis of commercial insurance data by Milliman, a national healthcare consulting firm. Patients with acute leukemia pay more than $5,100… Most patients now diagnosed with cancer don’t understand how severe the financial strain will be, said Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research in Seattle.

“Analyzing bankruptcy records and cancer registries in Washington state, Ramsey found that cancer patients were more than 2½ times more likely to declare bankruptcy than people without the disease, even after accounting for differences in age, socioeconomic status and other factors.

“‘Suddenly, people find they owe hundreds or thousands of dollars,’ Ramsey said. ‘If they are young or working in a low-wage job, they’re not going to be able to pay….Makes no sense’

“Several Western European countries, including Britain and France, which have national healthcare systems, limit cost sharing for people with some chronic conditions, making prescription drugs available at no cost to patients… Holland, which relies on private insurance, requires insurers to exempt primary-care visits from any cost sharing.

“In the U.S., however, federal law generally prohibits high-deductible plans from exempting these services, forcing patients to pay for them in full until they meet their deductibles… 

‘What we’re doing makes no sense,’ said David Grabowski, a health policy researcher at Harvard Medical School… Grabowski’s work has shown that epilepsy patients like [one patient with constant epilepsy] who have high out-of-pocket medical costs were less likely to fill their prescriptions and more likely to end up in an emergency room or to be admitted to a hospital, leading to higher costs.

“‘We want these people to take their medications. That’s not only good for their health, it’s good for overall healthcare spending,’ he said. ‘This is penny wise and pound foolish.’…‘Heartbreaking’… Across the country, organizations that work with sick patients increasingly report being called upon to aid people who cannot afford care, despite having insurance.”

What kind of a system makes healthcare unaffordable even for those with health insurance? What kind of insured medical coverage has co-pays and deductibles so high that even people with normal healthcare policies file medical bankruptcies? People in the rest of the developed world have it so much better than average Americans. That those most deeply negatively impacted are often in Trump’s populist base is an irony that seems to be lost on his supporters.

              I’m Peter Dekom, and who would ever have thought that America could be so cruel and uncaring to its own citizens?!