We have effectively taken the “health” out of “health insurance.” And we did that by commodifying and privatizing such a basic need. Health is a straightforward concept, a crucial element of human life and survival. Insurance is a cold word that intimidates and conjures confusion. People widely misunderstand how their insurance works, or even what it is—as evidenced by findings proving many Americans do not know that Obamacare and the Affordable Care Act are the same thing. Beyond that, plenty of Americans also do not realize that they have Obamacare if they have insurance that complies with the law. And with close to 20 million people now with insurance who did not have it prior to the law, it’s safe to say most of our country relies on the ACA. So repealing the Affordable Care Act without replacing it is nothing short of murder.
That’s part of what makes the Republicans loudly trying to eliminate the ACA for so many years so offensive—especially when they clearly have no concrete suggestions on what to do instead. The audacity on top of that to repeal the law without replacing it shows that there is more focus in Congress and within the new administration on undoing Obama’s legacy than on providing for the people. Thankfully at least some Republicans, in private of course, can admit that they have few original ideas, and that what they will put forth is crucial. Audio leaked by the Washington Post of a closed door meeting in Philadelphia on January 26th of Republican power proved that, with Representative Tom McClintock saying, “We better be prepared to live with the market we’ve created..That’s going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.” Unfortunately it takes ego and reelection for them to meaningfully consider what they’re going to give us.
Thankfully, despite the middle of the night vote-a-rama action in the Senate, and Trumps executive order on inauguration night, the law still at this point stands. Both of those moves are indicative of how unprepared, yet desperate, republicans are to repeal the ACA. But it is just that, desperation. The middle of the night senate vote was merely procedural, although it did set the stage for them to repeal major aspects of the law soon without a filibuster from Democrats. In terms of the executive order, as the Times put it, ”[it] should be seen more as a mission statement, and less as a monarchical edict that can change the law.” But they clearly are ramping up to some kind of concrete change soon, so what will happen then?
One big question are the subsidies that the ACA sanctioned—government money paid directly to insurance carriers towards your premium (your monthly cost) on the insured’s behalf. Officially referred to as Tax Credit Subsidies, as they are granted based on income brackets and age demographics, and reconciled on the following year’s taxes (if you make more money than you reported, you owe back the portion of your subsidy you didn’t qualify for; if you make less money than you reported, you get a tax credit for what you would have gotten), subsidies have allowed a majority of Americans to get insurance at a fraction or no cost. With their budget slashing in the first week of Trump’s presidency, it would seem that the subsidized premiums would be one of the first things to go. At that point, most people would have to forfeit their insurance, leaving millions exposed and uninsured.
Part of why premiums have become so exorbitant is because the ACA also prevented insurance companies from being able to exclude preexisting conditions—meaning turn people away because of or refuse to pay for conditions diagnosed before their policy goes into effect. If the insurance company has to spend more money on care, they hike the premiums up. What a lot of people don’t realize though is that insurance rate increases are state approved. Companies must turn in their claims-losses and rate increase proposals, and the states either deem them fair or not. So let’s say hypothetically congress guts the subsidies and the preexisting condition protections, that would mean that, without a replacement in effect, people would then have policies that would suddenly be incredibly more expensive than they originally were prepared for, and it would be at their insurance company’s discretion if they would start denying claims for preexisting conditions because there would no longer be anything saying that they could or couldn’t.
One thing that could help people is if Congress also repealed the provision limiting when someone can enroll in coverage. As it stands now, anyone can get insurance during Open Enrollment, a three month period stretching most often November through the following January for the past four years. Outside of that you have to have one of six provable “life events” to qualify you for a “special enrollment,” which are getting married, divorced, having a baby, moving to another region of the country, turning 26 and falling off a parent’s policy, or losing coverage through an employer, and you must apply within 60 days of that event. If Congress were to make it so you could enroll at any time, as it was pre-ACA, that would hopefully at least give people some freedom to try and find something new once their insurance is ripped from them. And we can only assume that because of all of this they would also eliminate the tax penalty for not having ACA-compliant insurance, although who is to say how much logic is going to apply to this piece-meal gutting of the American healthcare system.
After they have done all of that, what will most likely happen will be one of two things: they will let us squawk and suffer until they release a new bill that would sweep a whole new system into law, as the ACA functioned, or they will slowly introduce smaller, incremental measures that will chip away at having some semblance of a plan—neither is good, and both will kill people. It does look like the latter is more probable however, with Representative Greg Walden cryptically saying, “If you’re looking for another 2,700 page bill to emerge, you’re going to be waiting until the sun doesn’t come up, because that’s not how we’re going to do it.” I said months ago, there’s no way they will repeal and not replace the ACA, but if we’re all realizing anything right now, it’s that things we never thought possible can and will happen. Our only hope is the more sane Republicans will block a repeal without a replacement for fear of losing their seats in two years. Until then, much like the pregnant woman a nurse friend of mine was telling me about the other day, who was inconsolable at her check up fearing loss of coverage, we will just have to wait and try not to panic.
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Image: majunznk, CC-BY
Chloe Stillwell is a Nashville-based columnist focusing on politics, culture and feminism.