The Shit You Actually Need to Know About Healthcare - By Greer Clem

I admit it: I don't know as much about the American healthcare system as I should. So, I'm going to try to break down what is happening in Washington, why Obamacare is our best option, and why we (I) need to give a shit.

This last part may seem obvious, but to people like myself who are recent college graduates and new to the workforce, the impact of healthcare may not have sunk in yet. I am covered by my parents health insurance until I am 26, as are many people my age, (BTW you can thank Obama for that) so we haven't yet had to weigh the costs and benefits of insurance companies vs. paying out of pocket. So, what do we know and what to we need to learn? We know that an enormous piece of Trump's campaign platform was to repeal Obamacare and offer a better solution to Americans. We know that some people are mad about Obamacare. And we know that Democrats are fighting really hard to save Obama's most resounding piece of legislation. Now we ask: Why?

Let's start by addressing the angry people. *calm Mom voice* "So, what is upsetting you?" Well, it shouldn't be all that surprising that legislation that has been enacted for less than a decade is still in the adjusting phase. Increased coverage naturally meant increased costs in the short-term; we always knew this would happen but people aren't happy they're paying more.

Costs have been higher for both individuals and companies. About 30 million people buy private health insurance. If that insurance didn't meet the Obamacare standards (10 essential benefits discussed below) then their policies were cancelled, meaning that they had to seek sometimes more expensive options. Okay, I get it, that would make me frustrated too. 

Between 3-5 million additional people lost their company-sponsored healthcare because it was cheaper for companies to cancel their policies and pay the penalty to employees than to pay the cost of revising their plans under the ACA. Also a bummer. 

Pharmaceutical companies had to pay big in fees as well while Obamacare tried to raise the money to close the "donut hole" in Medicaid. What is this random donut hole term doing in this article, Greer? Good question. The Medicaid "donut hole" means that there is a coverage gap in which beneficiaries of Medicaid still have to pay the full cost of their meds even though they are also paying their premiums. This means a lot of seniors, many who no longer have incomes, are paying full price for their prescription meds even under Medicaid. It was a goal of Obamacare to close this gap by 2020. Makes old people happy, makes pharma companies cranky. 

Here's why Washington Republicans are unhappy: in 2013 the ACA raised the income tax for the wealthy. Let's think: who do we know in Washington who is wealthy and hates taxes...

Okay, so these are just a couple of the issues people have with the Affordable Care Act, all of which boil down to the fact that it is not entirely affordable for everyone. This is not a slap in the face to the Democratic party; President Obama himself acknowledged that the ACA needed work, as any new legislation does. In an interview for New York Magazine in October, 2016, he said, "They’re eminently fixable problems in terms of strengthening the marketplace, improving the subsidies so more folks can get it, making sure everybody has Medicaid who was qualified under the original legislation, doing more on the cost containment. But you hit a point where if Congress just is not willing to make any constructive modifications and it’s all political football, then you’re getting a suboptimal solution." And he's absolutely right. The problem? Trump is now President with a Republican house majority and dumb and dumber (Mitch McConnell and Paul Ryan) are acting as spokespeople for a cause they do not fundamentally understand. 

Before we get to why Ryan and McConnell are posing dangerous threats to American healthcare, we have to discuss why Obamacare is our best option and and what fundamental parts need to be preserved. Obamacare's successes are primarily threefold:  it provided insurance to 20 million people previously not covered, it allows people like myself to stay on their parent's insurance plans until they are 26, and it guaranteed that people with preexisting conditions would be covered by insurers. 

Under Obamacare, all insurers must cover the 10 essential health benefits I mentioned above. This means that things like addiction and mental health are, for the first time, being treated like legitimate medical issues. It also includes pregnancy and childbirth, which should fundamentally be covered by all insurance policies in the history of forever - you would think this didn't need to be established, but it did. 

How important is the preexisting conditions piece? In the words of our current President, "It's huge." This means that if you have a preexisting condition, your insurer cannot drop you or raise your premium cost if you get sick. If you haven't yet watched Jimmy Kimmel tell you why this matters, you need to. Trump said on April 30 that preexisting conditions would be covered under the GOP's revised healthcare plan. The next day, Sean Spicer confirmed the same thing, citing the MacArthur Amendment as a key element of the GOP revisions. What exactly is this amendment? 

Another good question, Greer, gold star (yes, I am rewarding myself for learning about health care). The MacArthur Amendment was proposed by Representative Tom MacArthur of New Jersey's 3rd Congressional District and basically creates loopholes for insurers so they don't have to cover preexisting conditions. The Amendment allows insurers to set premiums based on people's "health status," which is determined by examining your current and past health status and then predict how expensive you will be to insure. What's the problem with this? It means that sick people will be charged more for insurance. They cannot technically refuse you coverage, but they could look at a preexisting condition as part of your "health status" and charge you a premium you could not reach, forcing you to either pay out of pocket or seek insurance elsewhere. It also allows states to opt out of some Obamacare regulation, which makes sense because we all know congressional republicans love more money and states' authority. 

Do all Republicans support the MacArthur Amendment? Thankfully, no. It has been backed by the House Freedom Caucus or, as I like to call them, the Ultra-right Egomaniac Caucus. That's about 30 people who have offered their support of the AHCA plan now including the MacArthur Amendment. Earlier this month, about 49 House Republicans were reportedly leaning towards "no" on the AHCA, and only half of those were moderates. This means that this time around, Trump would still need at least an additional 15 moderate republicans to switch to "yes," which seems increasingly unlikely because the MacArthur Amendment only made the AHCA a more extreme version of the previous GOP revisions. And that's all just to get the bill out of the House. 

So, we have some good news and some bad news, but, more importantly, we have people still without affordable healthcare. The proposed AHCA certainly won't do anything to change that, and that's not a partisan opinion, it's fact. Trump has promised insurance for every American at a lower price, but that is not a promise he can deliver on. Obamacare has flaws to be worked out, this is absolutely true, but the parameters designed by the Obamacare legislation are our best chance for universal healthcare. Obama's point about strengthening the marketplace is, I think, the most crucial. Obamacare built the foundation but we have to work to strengthen the support around it, otherwise it cannot support everyone. I certainly don't have the answer on how to do that, but I do know that the AHCA is not it.

Preexisting conditions, including addiction and mental health, should not condemn any citizen to life without health insurance, or to a premium that they could never reach because an idiotic New Jersey Congressman created a loophole for big Pharma companies. I am hopeful, however, because it seems that even most Republicans in the House understand that the GOP doesn't have the faintest idea how to remedy the flaws under Obamacare; they're just throwing shit at the wall and hoping something sticks so that they can say Obama didn't accomplish anything and Trump can pass some legislation. We cannot let this happen - healthcare is the most important issue our generation faces. Yes, we have to deal with national security, education, and immigration - but we cannot do anything unless we can take care of our own. 

Well then, I'm off to watch some TV and not think about healthcare costs, because, thanks to Obama, I don't really have to until I'm 26. House Democrats, keep fighting. House Republicans, keep listening. If we communicate with each other, regardless of what a couple idiots in Washington say, and tune out the bullshit, I do actually believe we can work towards affordable healthcare for every American. 


Greer Clem