This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series.
As members of Congress return today after their July 4 break, they are hoping to rapidly conclude their attempt to repeal and replace the Affordable Care Act.
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The health bill overhaul, one of Trump’s consistent campaign promises, has been vexing his administration and angering the general US population. In fact, only 12 percent of Americans support what Trump and the Senate aim to do with the country’s health care system.
Doctors, nurses, churches and myriad other health care workers and affiliates have expressed vehement opposition to the attacks on health care inherent in the “repeal and replace” plan put forward by Trump and the Senate.
“The whole proposal is egregious,” Aaron Katz, a principal lecturer in the field of health services and policy at the University of Washington, told Truthout.
Katz said that in the near term, the Trump/GOP health care plan will make needed health care unaffordable for tens of millions of Americans by rescinding the Medicaid expansion and reducing subsidies in the private health insurance market.
Dr. Bruce Amundson, the president of Washington Physicians for Social Responsibility, was also highly critical of the Trump/GOP plan.
Amundson, who is a family physician as well as a former faculty member at the University of Washington School of Medicine, also noted that the US already spends more money on health care than the rest of the world combined
Underscoring Amundson’s point that this has not made the US the healthiest country, a 2013 study by the National Institutes of Health, National Research Council and the Institute of Medicine, titled US Health in International Perspective: Shorter Lives, Poorer Health, revealed that while the US is among the wealthiest nations in the world, it is far from being the healthiest.
“Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries,” according to the report.
“The US health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other ‘peer’ countries.”
On top of that, Trump and the GOP are aiming to make the US’s position even worse, and causing 22 million Americans to lose their insurance and cutting $800 billion from Medicaid are just part of the story.
Impacting the Most Vulnerable
Amundson thinks the most destructive element of the Trump-approved Senate legislation is that it reinforces the movement toward greater income inequality by favoring the wealthiest 5 percent to 10 percent of Americans.
“Specifically, the Affordable Care Act largely paid for the expanded insurance for the poor, Medicaid, through a 3.5 percent tax on the investment income on top earners,” he explained. “This represented a tiny wealth transfer to assist the most needy, and was a tiny step toward the European social democracies and their model of a humanistic role for government.”
In contrast, the Republican plan, according to Amundson, “reflects an appalling lack of values for equity and fairness in our society — removing this tax while reducing the extent of Medicaid’s coverage.”
Established as part of the social welfare system in the 1960s, Medicaid has been our relatively small but real commitment to health care access for the most poor and vulnerable population in the US.
Obamacare expanded Medicaid by removing the decades-long policy of shared state/federal partnership for the costs, Amundson added, emphasizing that Obamacare allowed states to expand Medicaid, because “the federal government agreed to pay 100 percent (with the wealth transfer dollars),” which was “the only way to get states with struggling Medicaid volumes and costs to join in.”
For better or worse, having health insurance in the US is a necessary precondition for access to health care in our system, and Katz said this is a major part of the problem.
“In the mid-term, the change in the basic nature of Medicaid — from an entitlement to a per capita capped program — will force states to throw even more people (especially those with costly chronic illnesses or disabilities) off the program,” he said, adding that the GOP plan “will also cut services, or cut already meager payments to providers (which will further reduce access).”
Katz also expressed concerns about the GOP’s plan impacting people with disabilities and the elderly.
“Medicaid is the largest funder of long-term care, including nursing homes,” he said. “It’s the most costly group of services in Medicaid. So, when federal support shrinks, those are the groups states will have to go after, since that’s where the biggest costs are.”
“The most vulnerable members of our population are currently on this government insurance program,” he explained. This includes poor people, people with mental health and substance abuse problems, and people with developmental disabilities. In addition, Amundson pointed out that family members in nursing homes, many of whom have Alzheimer’s, are now covered largely by Medicaid. He said the Republican plan would hurt “our citizens with the most severe needs … exhibiting a harshness that must not reflect the values of a communitarian society.”
Amundson cites the fact that young and single mothers are among the most economically impacted by the GOP plan, and they are also a population for whom Medicaid is critical.
“Roughly half of all US births are by women on Medicaid,” he said. “Remove maternity benefits from Medicaid plans? This is not only medically destructive, it is cruel. This would be society at its most harsh and punitive.”
US Health Care Already in Decline
In the mid-1990s, the US ranked 24th in overall healthcare amongst the world’s countries. Now, however, the US ranks 37th, according to the World Health Organization.
“Our health compared to other countries is declining,” Amundson pointed out.
Part of this is because people cannot or will not access health care because it has simply become too expensive.
“It’s the leading cause of bankruptcy for people with insurance with high bills they can’t pay,” he added. “What is new is that this bill is certain to increase the number of uninsured. And this is at a time when most Americans want the safety of having access to health care without having to pay.”
As a former ER doctor, Amundson said he is sure people will have less access if Trump and the GOP get their way.
“What we have is a set of social policies that do not guarantee equal access to this modern set of health services,” he added. “The primary, ongoing and unresolved crisis in US health care is cost, and no national interventions to date have interrupted the relentless upward trajectory.”
Amundson went on to point out what he sees as a long-understood but largely ignored fact — that in any given year, 10 percent of insured Americans are responsible for about 70 percent of the costs.
“We can identify who they are, we know why, yet the insurance industry has failed over the decades to help channel comprehensive, coordinated, effective care to these complex individuals, which must happen to address the cost monster.”
Katz sees the solution to the health care crisis in the US as a publicly governed, universal health system that would be less expensive, less complex and fairer. While this would not solve all problems, he sees it as a necessary prerequisite to actually reducing health care costs and improving overall quality.
The Republicans claim the Affordable Care Act (ACA) is failing, and while the ACA has significant, real problems, the Senate and House Republican proposals would not only not solve those real problems, they would make all of them much worse: cutting Medicaid and insurance subsidies would mean that there could even be more than 22 million left without insurance in the long run.
“Allowing insurers to charge older people five times what they charge younger people will make the former’s premiums entirely unaffordable,” Katz said. “Reducing subsidies will put private insurance out of financial reach for even more middle-class people.”
Amundson is deeply disturbed by what he is seeing.
“The level of discussion in Congress on a subject as complex as health care is absolutely embarrassing for clinicians,” he concluded. “Insurance is not health care. Health services are intensely personal, relationship-based, and involve immensely technical and complex information. To have non-clinicians denigrate a service they know nothing about is at the core of this tragic and ill-informed policy debate.”