It’s December of 2023, and we are less than a year away from the 2024 presidential election. We should be worried, because President Biden’s popularity as reflected in the polls is lower than that of his likely opponent, #PO1135809. I can’t, for the life of me, understand why people think that it’s a good idea to give #PO1135809 another term in the White House, but that seems to be the case – at least for now.
We saw a couple of statements from #PO1135809 this week that warn us clearly about his plans. He confirmed in a public interview that he plans to be a dictator “on Day One” if he is reelected. We should take him both seriously and literally. He was never funny, and he is no longer even a bad joke.
Warning signs are flashing around the world. A second term for #PO1135809 would be a – well we don’t really have a term for BEYOND disaster, but that’s what it would be. You don’t have to trust me on this – Google “Trump” “second term” and “authoritarian” to see articles from around the world about this threat. The January/February issue of Atlantic (soon to be released) is totally devoted to this threat. We should all read it. Yes, sources like Atlantic are not free. It costs something under $100 per year, depending on what plan you select. Eight dollars a month, give or take. Quality journalism is worth paying for.
I have friends (acquaintances, tbh) who have decided to take the moral “high ground” and refuse to vote for either Biden or #PO1135809. They refuse to accept the notion that this is not the hillside to die on.
The media tend to focus on elections as horseraces – who’s ahead, who’s behind, who’s lagging, who’s coming up on the inside, who is the “dark horse” that you didn’t see coming. This is not helpful in our current situation. Instead of the “odds” of Biden winning reelection, we should be talking about the “stakes” at play here. What would a second #PO1135809 administration look like?
I saw something this week about what this would mean for the future of health care, as #PO1135809 has promised (once again) to get rid of the Affordable Care Act (Obamacare). Last time around, #PO1135809 and the people around him were too incompetent to actually accomplish this goal; this time, they are planning to be more competent and efficient – actually prepared for governing – and they could be successful.
So here’s what’s at stake in this one area – health care. I’ll write more about other issues in the upcoming weeks. As you read this, think about what this would mean for you and the people in your lives. This is not an abstract issue.
This is from a White House report from earlier this year. This does not mean you should ignore it because it is likely to be biased. You should take the biases into account as you read it, thinking about alternative ways of presenting the information or alternative interpretations of the data. But these are verifiable facts – not “alternative facts.” Sometimes you can trust what you read on the internet. Here’s the link to the White House report, including access to the sources of the information that supports their analysis. You can take a look at it and decide if you think the data supports the conclusions.
If Republicans are successful in repealing the Affordable Care Act and making deep cuts to Medicaid:
Millions of Americans Will Have Higher Health Care Costs
More than 100 million people with pre-existing health conditions could lose critical protections. Before the ACA, more than 100 million Americans with pre-existing health conditions could have been denied coverage or charged more if they tried to buy individual market health insurance. Republican repeal proposals either eliminate these protections outright or find other ways to gut them.
Up to 24 million people could lose protection against catastrophic medical bills. Before the ACA, insurance plans were not required to limit enrollees’ total costs, and almost one in five people with employer coverage had no limit on out-of-pocket costs, meaning they were exposed to tens of thousands of dollars in medical bills if they became seriously ill.
Tens of millions of people could be at risk of lifetime benefit caps. Prior to the ACA, 105 million Americans, mostly people with employer coverage, had a lifetime limit on their health insurance benefits, and every year up to 20,000 people hit that cap and saw their benefits exhausted just when they needed them most.
Millions of people could lose free preventive care. The ACA requires private health insurers to cover preventive services, like cancer screenings, cholesterol tests, annual check-ups, and contraceptive services, at no cost. Before these requirements were in place, millions of Americans with health insurance faced cost sharing – sometimes high costs – for these services, which is part of why the ACA resulted in increased use of critical preventive care.
Over $1,000 average increase in medical debt for millions covered through Medicaid expansion.
Repealing the ACA, in particular the expansion of Medicaid to low-income adults, would reverse major gains in financial security. Within the first two years of the ACA’s expansion of Medicaid, medical debt sent to collection agencies dropped by $3.4 billion, and there were 50,000 fewer medical bankruptcies. Among people gaining coverage through expansion, medical debt fell by an average of over $1,000. Expansion states also saw significant drops in evictions compared to non-expansion states.
Tens of millions of people could see their prescription drug coverage scaled back. Prescription drug coverage is an optional benefit under Medicaid. If states faced large cuts to their federal Medicaid funding, millions of Medicaid enrollees could see their coverage scaled back or have a harder time getting their prescriptions because of extra red tape.
Millions of Americans Will Lose Their Health Insurance
40 million people’s health insurance coverage would be at risk. Over 16 million people have signed up for ACA marketplace coverage for 2023, over 22 million people are enrolled in Medicaid expansion coverage available due to the ACA, and another 1 million people have coverage through the ACA’s Basic Health Program. The total number of people with some form of ACA coverage has risen significantly since 2017, when the Congressional Budget Office estimated the House-passed repeal bill would grow the ranks of the uninsured by 23 million.
An additional 69 million people with Medicaid could lose critical services, or could even lose coverage altogether. Slashing federal funding for Medicaid would force states to make Medicaid eligibility changes that would make it harder to qualify for and enroll in Medicaid coverage. States would also likely consider capping or limiting enrollment, cut critical services, and cut payment rates, making it harder for people with Medicaid to access care.
Thousands more preventable deaths each year.
The ACA Medicaid expansion is preventing thousands of premature deaths among older adults each year, research finds, likely because it improves access to care, including medications to control chronic conditions and preventive care such as cancer screenings. ACA marketplace coverage also prevents premature deaths.
Worse Care for Seniors and People With Disabilities
Over 7 million seniors and people with disabilities could receive worse home care, with ballooning wait lists for those still in need. The number of people on home care wait lists has dropped by 20 percent since 2018. This progress would likely be reversed under a block grant or per-capita cap because there would be fewer dollars available for home care services, an optional benefit in Medicaid. Faced with large federal funding cuts, states would almost certainly ration care. That would likely mean wait lists for home care in the 13 states and DC that don’t currently have them, and skyrocketing wait lists in 37 states that do.
Hundreds of thousands of nursing home residents would be at risk of lower quality of care. Over 60 percent of nursing home residents are covered by Medicaid. With large cuts in federal funding, states would be forced to cut nursing home rates to manage their costs, as many states have done during recessions. Research shows that when nursing homes are paid less, residents get worse care.
Millions of People Will Lose Access to Opioid Treatment and Mental Health Care
Millions of people could lose access to substance use treatment or mental health care. Across the country, the ACA, especially its expansion of Medicaid, has dramatically expanded access to opioid treatment and other substance use disorder care, including increases in medication-assisted treatment prescriptions for opioid and other substance use treatment and improved access to mental health care.
34 million children are at risk of losing guaranteed access to mental health care. Past Republican plans proposed ending Medicaid’s guarantee of comprehensive health coverage for children. This would jeopardize children’s access to mental health care at a critical point in efforts to address the burgeoning youth mental health crisis. It would also cause children to go without other services, like annual check-ups and speech and physical therapy. And Republican proposals could endanger schools’ ability to bill Medicaid for mental health care, speech therapy, or physical therapy for students.
Rural Hospitals Would Be Forced to Close
More of the over 500 rural hospitals at risk of closure could close. The ACA, especially its expansion of Medicaid, helped cut hospital uncompensated care by about $12 billion, helping hospitals, especially rural hospitals, stay afloat. Between 2010 and 2021, nearly three-fourths of rural hospital closures were in states that have not adopted Medicaid expansion, with research finding that expansion disproportionately improved rural hospital margins and helped avert rural hospital closures. If the ACA is repealed, and millions lose coverage, closures among at-risk hospitals could increase significantly.
Separate from all these quantifiable harms, Republican ACA and Medicaid plans propose abrupt, unprecedented upheaval, with consequences for the entire healthcare system. In 2017, patient groups, physicians, hospitals, insurers, insurance regulators, healthcare experts, and governors from both parties all expressed alarm that ACA repeal could have far-reaching consequences for the stability of health insurance markets and the availability of affordable coverage and care.
Don’t talk about the odds. Talk about the stakes. It changes the conversation.
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