If the Trump administration, and the 20 Republican-dominated states that are suing to overturn the ACA, succeed, approximately 20 million people would lose their health insurance, or the federal subsidies that make insurance affordable for the working poor. Insurance companies no longer would be required to cover people with pre-existing conditions at no extra charge. Individual insurance plans would go back to having big coverage gaps.
As Matt Stieb wrote for New York Magazine April 1, “If the Trump administration has a domestic policy doctrine at this point, it could be described as the following practice: the appointment of industry insiders to Cabinet-level positions in order to deregulate or otherwise surgically dismantle the protections of a given department.
“In this spirit comes the announcement that Florida Senator Rick Scott intends to deliver on President Trump’s promise that the GOP ‘will soon be known as the party of health care.’ On [March 28], Trump told reporters that Scott, and fellow Republican Senators John Barrasso of Wyoming and Bill Cassidy of Louisiana, will lead the party’s push on health-care reform.”
“They are going to come up with something really spectacular,” Trump said, surprising Scott, Barrasso and Cassidy.
Trump has been pushing for two years to repeal Obamacare, and replace it with “something really spectacular,” but he admitted that so far, he’s got nothing. Still, that might be a good thing, if Rick Scott is his point man on health care reform. Scott’s health care experience was as former CEO of Columbia/HCA, which was fined $1.7 billion for defrauding of Medicare and Medicaid in the 1990s, in what the Justice Department called “the largest health-care fraud case in US history.”
Columbia/HCA agreed to plead guilty to 14 corporate felonies, but nobody went to jail. Ironically, Scott spent $75 million, mainly from his own fortune, to become governor of Florida in 2010, then he resisted efforts by convicted felons to regain their voting rights. He spent another $12.8 million of his family’s money to win re-election in 2014, and then he self-financed his 2018 Senate race with $63.6 million to unseat Sen. Bill Nelson (D).
After voter concerns about Republican attempts to repeal Obamacare without a replacement plan helped Democrats’ regain a majority in the House of Representatives in 2018, many Republicans were surprised when Trump tweeted that the GOP would become “the party of health care” and Republicans “will take care of pre-existing conditions better than they’re taken care of now.”
In the 10 years since Democrats passed the ACA, Republicans have been able to come up with little more than allowing insurers to sell insurance across state lines, turning Medicaid into a block grant so states could put their own restrictions on the program, and allowing insurance companies to sell “skinny” plans that offer less coverage at lower costs for people who bet they’ll stay healthy.
Scott has expressed some thoughts about keeping protections for people with pre-existing conditions, and requiring that consumers pay no more for drugs than they do in other industrialized nations, but he has little to show for it. As governor, he couldn’t get the Republican legislature to accept federal money to expand Medicaid to cover the working poor and Florida ranked near the bottom on access to basic health coverage. The rate of Floridians without health insurance was 12.7% in 2018, compared with a national average of 8.7%. Texas, which also rejected expanding Medicaid for the working poor, had the highest uninsured rate, at 17%.
Senate Majority Leader Mitch McConnell (R-Ky.) has no plans to mess with health care reform. ”I look forward to seeing what the president is proposing and what he can work out with the speaker,” he said in an interview with Politico March 28. “I am focusing on stopping the ‘Democrats’ Medicare for none’ scheme.”
Rural communities have suffered from the Republican indifference to health care, as many small towns are at risk of losing their hospitals. The North Carolina Rural Health Research Program lists 102 rural hospitals closing since January 2010, including 17 in Texas and 11 in Tennessee. Both states refused to accept federal money to expand Medicaid to cover the working poor. The latest casualty was the Cumberland River Hospital, a 25-bed facility in Celina, Tenn., that closed March 1 after the Cookeville Regional Medical Center, which operated the Celina hospital 35 miles away, couldn’t find a buyer.
“Unfortunately, many rural hospitals across the country are having a difficult time and facing the same challenges, like declining reimbursements and lower patient volumes, that Cumberland River Hospital has experienced,” CEO Paul Korth wrote to Blake Farmer of Nashville Public Radio, who profiled the impact of the loss of the hospital — and another 147 jobs — on the town of 1,500 whose nearest hospital is now 18 miles away. That adds another 30 minutes through mountain roads for those who need an X-ray or blood work. For those in the back of an ambulance, that bit of time could make the difference between life or death, Farmer noted April 7.
More folks on TennCare, the state’s Medicaid program, would have helped, but legislation to extend coverage to the working poor died during a special session in February 2015. Instead, the state chose to purge at least 128,000 children in low-income families who had been covered under TennCare.
Meanwhile, expansion of Medicaid has helped rural hospitals stay afloat in states like Colorado, which added 400,000 people under the ACA, John Daley reported for NPR in January 2018.
Hospitals in states that expanded Medicaid were about six times less likely to close than hospitals in non-expansion states, according to a study by the University of Colorado that was published in the January 2018 edition of the journal Health Affairs.
Colorado was one of 37 states, including DC, that expanded Medicaid under the ACA. That cut the state’s uninsured rate in half.
Richard Lindrooth, a professor at the Colorado School of Public Health and lead author of the study, says hospitals saw more people showing up to hospitals with that insurance — so Medicaid payments increased. That helped the hospitals’ bottom line.
“It’s not as though Medicaid is an extremely profitable form of reimbursement, but it is something,” says Lindrooth, a professor the University of Colorado’s School of Public Health. “On the margins, it certainly helps the hospitals’ cash flow.”
The ACA led to historic gains in health insurance coverage by extending Medicaid coverage to many low-income individuals and providing Marketplace subsidies for individuals below 400% of poverty. The number of uninsured nonelderly Americans decreased from over 44 million in 2013 (the year before the major coverage provisions went into effect) to just below 27 million in 2016. However, in 2017, under Trump, the number of uninsured increased by nearly 700,000 people, the first increase since implementation of the ACA, the Kaiser Family Foundation reported in December 2018.
Obamacare needs to be fixed, but Trump can’t be trusted, of course, and neither can other Republicans who have resisted realistic health reforms at every step. Private insurance had its chance to show it could provide universal coverage, and it failed. It’s time to expand Medicare to cover everybody. That will require a Democratic takeover of Congress and the White House. — JMC
From The Progressive Populist, May 1, 2019
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