Bob Cesca: Donald Trump Doesn’t Understand Healthcare
Vaporizing the entire law would not just hurt or literally kill Americans who have policies purchased through the state ACA exchanges, it’d harm almost everyone.
by Bob Cesca
Donald Trump doesn’t understand healthcare. He understands the Affordable Care Act even less, if that’s possible. He only appears to grasp that his Red Hats hate the ACA for reasons not a single one of them can adequately articulate, which, along with his obvious attempt to erase Barack Obama’s legacy from history, has motivated the president to reignite his war against the healthcare law.
He will likely fail, but don’t get happy. Last time around, he came damn close to killing the law, and it could happen again, especially knowing his new and treacherous strategy. Following a ruling by radical Texas conservative Judge Reed O’Connor striking down the law as unconstitutional, Trump has ordered his attorney general, Bill Barr, to support Judge O’Connor’s ruling rather than defending the law in court.
Barr’s predecessor, Jeff Sessions, had already stopped defending the law, but now the Justice Department has been mandated by the White House to join the litigation against the law as it heads up to the Fifth Circuit Court of Appeals, telling the court that O’Connor’s ruling on the ACA "should be affirmed." In other words, the word from Trump himself is that the entire law has to be obliterated, and once it is, Trump and the congressional Republicans will propose a replacement law. Maybe. After the election. In 2021. Maybe.
So, if the law is overturned tomorrow, if it’s stricken from the books leaving tens of millions of Americans without insurance, we’ll have to wait at least another two years before a replacement law can even be discussed in Congress. The mayhem that’d ensue would be the healthcare equivalent of overturning the Interstate Highways Law, with freeways torn up and American traffic disintegrating into chaos.
Donald Trump appears to be okay with all this. He apparently thrives on chaos, much to our collective dismay. But what he’s really trying to do here is a repeat of his approach with DACA -- repeal a vitally necessary law, then use its absence as leverage to get something else in exchange for a replacement law. In the case of DACA, Trump tried to use its reinstatement as leverage to get his wall. Fortunately, the courts stepped in, and that may end up happening with the ACA, too, but the stakes are so much higher given the millions who’d be harmed by this ridiculous gambit.
Vaporizing the entire law would not just hurt or literally kill Americans who have policies purchased through the state ACA exchanges, it’d harm almost everyone. Trump and his disciples don’t seem to understand that the ACA contains an entire roster of consumer protections and benefits that apply to all health insurance customers as well as Medicare recipients -- not just “Obamacare” customers (there is no “Obamacare” insurance plan, by the way).
If the ACA disappears, so will these consumer protections:
The Medicare Part-D prescription “doughnut hole” that forced retirees to go without meds for part of the year (or go broke paying out of pocket) is supposed to close by 2020 thanks to the ACA. But a Trump repeal would completely reopen it. There’s no immunity for retirees who voted for Trump. The reopening of this coverage gap would apply to everyone with Medicare Part-D prescription drug coverage. Everyone.
The ACA requires that all policies cover maternity care, preventative care, mental health, lab tests, disability care, pediatric care including dental and vision, prescription drugs, ER visits and so on. Repealing the ACA would instantly delete these requirements. Are Trumpers really okay with their kids, wives or disabled relatives losing coverage (to own the libs)?
The ACA eliminated annual and lifetime limits on coverage so you will always be covered regardless of your health status. Before the ACA, insurers would routinely force patients to pay out of pocket for medical care beyond these limits, forcing bankruptcies or loss of medical care. Shockingly, some insurers would simply revoke insurance coverage when a patient became severely ill or injured -- a dastardly corporate policy known as rescission. That ended with the passage of the ACA. Repealing the ACA, therefore, per Trump and O’Connor, would allow insurers to cancel policies for people in the midst of cancer or other forms of treatment. And after those patients lose their coverage, they won’t be able to buy new policies since, without the ACA, insurers could return to denying coverage to people with pre-existing conditions.
The ACA imposed limits on how much you have to spend out of pocket each year, which means insurance companies aren’t allowed to raise your deductibles and copays beyond a certain annual dollar amount. Repealing the ACA would remove those caps. So you could buy an el-cheapo policy, but the astronomically high deductibles would make the policy unusable. To be clear: these caps on deductibles and so forth would vanish for all insurance policies, allowing insurers to charge infinitely higher deductibles than the ones Trump keeps complaining about.
Per the ACA, insurers have to allow parents to keep their children on their policies until age 26. Thousands of young people would lose their coverage without the ACA.
The ACA mandates that insurance companies have to spend no less than 85 percent of your premiums on actual health care. Trump wants to eliminate this, which means Trump wants insurance companies to spend more on profits and bonuses and less on actual medical care.
Given the opioid crisis, it might be a good thing to retain the ACA’s funding for drug addiction treatment and prevention.
The ACA requires background checks on nursing home employees to help prevent elder abuse. No ACA, no more background checks, leading to more violence against elderly residents.
It’s worth noting here that due to Republican disinformation, few Americans know that the expansion of Medicaid isn’t financed by the states. Indeed, 90 percent of the cost for the Medicaid expansion is covered by the federal government, not state governments. So the cost excuse for red-state governors is mostly a lie. Nevertheless, the Medicaid expansion in the ACA, covering more Americans with low cost insurance, would go away without anything to replace it. Again, this means poor Trump voters as well as the libs.
The ACA makes it illegal for insurance companies to charge higher rates based on sex. I guess we already know why Trump would want to kill this consumer protection. Women are only for groping, right?
Again, it’s breathtaking to observe the sheer number of people who have no idea how the ACA is benefiting them personally -- and without any additional cost to them. Yes, premiums are rising, and the ACA needs to be supplemented with reforms to strengthen its cost-curve bending and to expand the affordability of coverage. One of the proposals I strongly supported back when the law was being passed was the addition of a public option -- a government insurance plan not unlike the one provided for government workers. This’d create competition with the private insurance companies since the government plan would be more affordable due to its lower overhead (the government isn’t a for-profit entity). Plus, the public option could be expanded to become Medicare For All.
But instead of pursuing additions to the law, perhaps even allowing Trump to re-brand the ACA as “Trumpcare,” he’s chosen instead to euthanize it. Trump always makes things worse for Trump, and this is no exception. Now he’s on record as wanting to burn the ACA to the ground, so even if he doesn’t succeed, he and his Trumper colleagues can be mercilessly attacked for simply wanting the ACA’s untimely demise. It’s an all-around self-inflicted loss for Trump, especially if he succeeds. Sounds weird, but it’s true. If the law disappears per his wishes, it’ll actually be far worse for Trump politically than failing to repeal it.
Not only does Trump not understand healthcare or the ACA, but he doesn’t understand how self-destructive he’s being. Oh hell, Trump doesn’t understand anything.
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