I’ve been writing this blog on and off for about eight years. And in all that time, I’ve tried to keep it as apolitical as possible. But, at my core, I am a writer. It’s all I’ve ever done for 30 years. And when writers can’t make sense of the world, or don’t know what to do with their feelings, well, they write.
So, spoiler alert, I am devastated by Tuesday night’s results for so many reasons. For an end to women’s reproductive rights. For an end to what I thought was a decent, inclusive country. For an end to a free press. For an end to LGBT rights. For an end to the respect we once had from the rest of the world.
But, since I earn my living as a healthcare writer, the one I’m going to focus on here has to do with the almost-certain death of the Affordable Care Act (ACA).
A Reminder of What We’ve Gained with the ACA
Just to recap, we have seen gains under the ACA, including:
- 20 million Americans have gained health insurance
- The US healthcare system has begun the massive shift from a volume-based system to one based on value and outcomes
- The uninsured rate dropped by 53 percent
- Young adults up to age 26 can remain on their parents’ health policies (which is why the uninsured rate in this age group has dropped 47 percent since 2013)
- More than $2.4 billion in refunds was returned to consumers because their health plans spent too much on advertising and marketing and not enough on health benefits
- Out-of-pocket costs for 39 million Medicare beneficiaries, as well as the rest of us, were eliminated for preventive services like cancer screenings, bone-mass measurements, annual physicals, and smoking cessation
- Health plans can no longer exclude people or charge them more based on preexisting conditions (like refusing to cover women with a history of domestic abuse or charging them far higher premiums)
- We now have caps on annual and lifetime dollar limits
- Millions of women now have access to contraception
- Hospitals have reduced readmissions and hospital-acquired complications, leading to a 50 percent drop in central-line bloodstream infections and a drop in avoidable readmissions that has saved an estimated 87,000 lives and $20 billion in healthcare costs
- Several major research programs have begun that have the potential to improve the health of every American, including the BRAIN Initiative, Precision Medicine Initiative, and cancer research.
Yes, there are problems. Yes, premiums have skyrocketed in some parts of the country. Yes, insurers have pulled out of exchanges. Yes, too many states refused to expand Medicaid, leaving millions of Americans caught in a no-man’s land of the uninsured. Some of these problems could have been fixed over the past six years; others are due to bigger issues in our healthcare system, namely cost.
I talk more about this in a recent blog.
Why This Election Could Lead to the Repeal of the ACA
Congress has voted more than 50 times to repeal the ACA and each time they were stymied in the Senate. Had the bill reached President Obama, he would have vetoed it.
They might still be stopped in the Senate, where the Democrats can filibuster. But through budget reconciliation and administration actions, they can overcome that.
And what will they replace it with? Something great, apparently. As the Trump website says: “By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.”
Highly unlikely, say health policy analysts and economists. In fact, according to the nonpartisan Congressional Budget Office, repealing the ACA would increase the federal deficit by $137 – $353 billion over 10 years (2016-2025).
But don’t take my word for it. Here are just a few things worth reading from Health Affairs, the Journal of the American Medical Association, the New York Times, the nonpartisan Congressional Budget Office, and Kaiser Health News.
I’m now returning to bed and curling up into a fetal ball. Obviously, I have not yet made it through the stages of grief.