ACA Repeal Passes the House: What Does This Really Mean?

In a 217-213 vote, Republican members of the House of Representatives managed to pass a bill yesterday (May 4th, 2017) that will supposedly begin the process of repealing and “replacing” the Affordable Care Act. While the President and members of Congress are celebrating their symbolic victory, it is important to pay attention to the big picture. The first noteworthy subject is the Senate, which has promised a deliberation process that will last upwards of six weeks and include a proper evaluation by the Congressional Budget Office. There have also been hints from more than one Republican Senator that the bill that the Senate will vote on will look little, if at all, like the bill that exited the House today. Now, given whose hands this is in, that’s not necessarily encouraging in itself– a new bill doesn’t necessarily mean a better bill. That said, the new bill would then have to return to the House for approval, and given what happened the last time the House had a more moderate healthcare bill in front of them, one can imagine that negotiation process will be…difficult, at best. Assuming the Senate passes a bill, it will then most likely go to committee for debate and compromise before coming to a vote in both houses once again. In short, this is far from over.

That should not, however, serve as an excuse to be anything less than acquainted with the nature of the bill as it presently stands. Most notably, the classification and management of individuals with pre-existing conditions has been at the forefront of conversations, and rightfully so. While we do not fully know what is and is not funded by the bill yet–neither do many Republicans who voted for it– we have had several glimpses into its contents. First, an amendment to the bill proposed by Representative Tom MacArthur (R-NJ) will allow states to petition the federal government for the right to charge individuals with pre-existing conditions more. States who take advantage of this will be required to maintain a so-called “risk-sharing” plan, which will be partially subsidized by the eight billion dollar amendment that was added yesterday, May 3rd, to help cover the cost. The AARP, among others, have described this funding as inadequate. The bill also does not define pre-existing conditions that would qualify for the waiver– meaning any condition identified by insurance companies would likely be at risk. Here are some examples:

  • Mental Health: Anorexia Nervosa, Bipolar Disorder, Bulimia Nervosa, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Schizophrenia, etc.
  • Behavioral/ Developmental Health: Autism Spectrum Disorders, Down Syndrome,   Attention Deficit (Hyperactivity) Disorder, Tourette’s Syndrome, etc.
  • Chronic Physical Health Conditions: Arthritis, Asthma, Blindness, Cancer, Deafness, Diabetes, Epilepsy, Heartburn, Hepatitis, Heart Disease, HIV/ AIDS, Migraines, Obesity, Osteoporosis, Paralysis, Tooth Disease, Ulcers, etc.
  • Women’s Health: Cesarian section, Endrometriosis, Menstruation, Ovarian Cyst,  Premenstrual Dysphoric Disorder (PMDD), Postpartum Depression, Polycystic Ovarian Syndrome (PCOS), as well as surviving domestic violence or sexual assault, etc.

For a full list of conditions, see below, courtesy of Igor Volsky:

Now, first and foremost, health insurance absolutely is a game of odds: many of these disorders do carry a higher risk of needing health care, and some would argue that that means it is reasonable to ask those people to pay more. This might seem fair in the absence of context, but looking closer reveals the myriad problems with such a mentality. First, many chronic and deadly diseases disproportionally affect minorities in this country, particularly people of color as systemic inequalities in socioeconomic status make access to adequate nutrition, as well as preventative and responsive care more difficult. This reality is further complicated by the decreased likelihood of adequate government intervention in minority-prevalent and low-income areas facing public health crises. Flint, Michigan, a city in which more than half of residents are African-American and the average resident is living below the poverty line, tells this story as well as anywhere: residents remain without clean drinking water three years later. So, minorities are more susceptible to disease and less likely to receive federal aid to manage public health crises. Now add the likelihood of facing discrimination when seeking care, and subsequent inequities in the care provided to people of color, individuals of low socioeconomic status, non-heterosexual individuals, transgender or gender non-conforming individuals, women, individuals with low levels of education, and people with disabilities– a likelihood high enough to compel the CDC to begin issuing annual reports on the subject. Finally, consider that the people most disproportionally affected by these diseases, and the most likely to receive discriminatory and unequal care, are also individuals most heavily impacted by financial inequities– namely, the wage gap, and discriminatory hiring practices, assuming they have the necessary documentation and ability to work in the first place. It is also important to note that, regardless of minority status, many of these diseases would make it difficult for a person to work full time, or at all. So, is it reasonable to demand higher payment from these individuals, or from people who are healthy and making more money than average? Maybe it’s the liberal in me, but it seems two things should be clear: 1) if the United States is going to continue to tout the myth of American Exceptionalism, we need to get on board with other leading nations in recognizing healthcare as a fundamental human right– not a right of the wealthy, or even a right of citizenship; 2) if changes to the Affordable Care Act need to be made, it is because the ACA does not do enough to progress healthcare in the United States towards a single payer system, not because it does too much.

One would imagine it is for this reason that Democrats in the House of Representatives sang “Na Na Na Na, Na Na Na Na, Hey Hey, Goodbye” at House Republicans yesterday following the passage of the bill, with the obvious implication being that those who voted to take healthcare away from their constituents will have a difficult time getting re-elected. So, while Republicans gleefully celebrate the first step in reversing human rights progress, it is our job to ensure our Democratic representatives were correct, and to fight against this bill–or whatever version of it emerges from the Senate–with all of our efforts. It is no understatement to say that there are millions of lives on the line.

Finally, for your daily dose of irony, I give you this:

Chaffetz

Yes folks, that is Representative Jason Chaffetz (R-UT)–who just had surgery for a pre-existing condition in his foot–gleefully rolling into Congress to take away your ability to afford to do the same. Chaffetz also recently announced his decision not to run for re-election in 2018. From the looks of things, that seems like a sensible decision to me.

— This is the ALF, signing off.