Repeal and (Don’t) Replace

By John Lawrence

(Source: LaDawna Howard/Flickr/CC-BY-2.0)

“Repeal and Replace” Just a Slogan

Republicans were fine with the way it was for the health care system before Obamacare went into effect. So why not just go back to the good old days when a pre-existing condition was enough to let an insurance company reject you from coverage?

The good old days when price gouging by insurance companies was the order of the day. The good old days when pharmaceutical corporations could charge whatever they want for life saving drugs. Oh, that part is still true under Obamacare.

The “Repeal and Replace” mantra was always nothing more than a slogan. Republicans have had 8 years to suggest a different system or enhancements to the one currently in effect. The sticking point is the pre-existing conditions part of Obamacare. According to a Kaiser Family Foundation Health Tracking Poll, 49 percent of respondents said they or a family member have a pre-existing condition. So eliminating that provision of Obamacare will affect a lot of Americans and Trump voters in particular. But Republicans will probably bite the bullet and do it anyway.

First of all Obamacare expanded Medicaid which is health care coverage for poor people. Well, poor people are not the Republicans’ traditional constituency. Rich people are, and rich people don’t have any problem with their health insurance coverage even if they have to pay through the nose for it. It’s a minor part of their expenses. Obamacare also gave subsidies to many people to get health insurance coverage. Well, people needing subsidies are not rich. The rich don’t need subsidies from the government. So Republicans don’t mind canceling this provision also. That leaves people who don’t need financial support or subsidies to provide health insurance for themselves. That means rich or better off Republicans.

Republicans don’t care that 20 million people have health insurance due to Obamacare that didn’t have it before because that’s 20 million poor or lower middle class people, people that vote for Democrats. Republicans would be happy to see all those people lose their health insurance as they subject them to the free market. After all they’re great believers in the free market. If you can’t afford to pay, you go without, and that’s what Republicans believe in. Whether it’s food, shelter, education or health insurance, Republicans don’t care if those that can’t afford to pay go without.

What About Emergency Room Care for Those Who Can’t Pay?

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So that means that poor people will have to rely on going to the emergency room every time they have a health problem? Don’t count on that either. It’s simply a law that emergency rooms have to take in people who can’t pay and provide some treatment at public expense. That law can be repealed by a Republican Congress just as easily as they can repeal Obamacare. That means that poor people will not be able to access emergency rooms either. They will have to rely on charity as a last resort. Republicans do believe in charity. After all isn’t that the American way? Rich people helping poor people instead of the government helping them? Noblesse oblige.

Pretty much charitable institutions are dependent on private philanthropy to keep them afloat. You are increasingly besieged by charitable institutions asking you to support them. Even at the check-out counter. Every time you buy pet food, you are asked by Petco to donate to help a homeless animal. Of course, you are not asked to contribute to homeless humans. They can fend for themselves and pull themselves up by their own bootstraps, those lucky enough to have boots, that is.

Even though Trump hasn’t come up with a replacement plan, House speaker Paul Ryan has several ideas. One is that, even if you lose your job at which your employer was paying for health insurance, you would still be allowed to pay for it yourself and not lose coverage. Of course, if you lose your job, you could ill afford to pay out of your pocket for health insurance. But that gets back to the Republican principle if you can’t pay for something you should do without. And if you miss one payment, that is enough for your health insurance provider to cancel your policy.

Another Republican mantra for replacing Obamacare is to allow health insurance companies to sell insurance across state lines. The idea is that by eliminating the red tape associated with state insurance regulation, insurers will be able to offer national plans with lower administrative costs. Oh, how the Republicans love to deregulate. There would be fewer rules imposed by the states, and insurers would only have to comply with minimal Federal regulations. I emphasize the word minimal. Supposedly this would increase competition among health insurance companies, and Republicans are always in favor of more competition, that is, unless the various corporations merge. Mergers and acquisitions are something Repubs like even more than competition.

Pre-existing Condition? No Problem

Back in the good old days, people with pre-exisitng conditions were covered by what was known as “risk pools.” It has been reported:

For sick patients who cannot continue coverage, Ryan’s plan calls for a return to state-run high-risk pools. These pools allow sick people to buy insurance separately, while states, insurers and the federal government help subsidize the cost. The president-elect’s website says he supports risk pools.

Risk pools have a long and controversial past. Before the ACA was passed, 35 states ran risk pools for people with preexisting conditions ranging from cancer and diabetes to more minor afflictions such as arthritis or eczema. Premiums for risk pool coverage were as much as 250 percent more than a healthy person would pay for individual insurance, and some states, overwhelmed with sick patients, had wait lists for coverage or imposed other restrictions, said [Cheryl] Fish-Parcham [Private Insurance Program Director, Families USA].

“Going back to risk pools is going back to the bad old days,” she said.

“High-risk pools served only 1 percent of the population back in 2008,” said Fish-Parcham. That wasn’t anywhere near the number of people who needed coverage but couldn’t afford it, she noted, adding: “Risk pools simply didn’t work.”

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Another way insurance companies get out of paying a lot of money is life time caps. Republicans would be happy to see that as part of the “replacement.” So if you have a serious chronic condition, you will be treated up until the time when you reach your life time cap. After that you’re shit out of luck. Your benefits will have run out. It’s back to the risk pool for you. Or you can throw yourself on charity. Maybe have someone open a Go-Fund-Me website for you. Or you might win with Publisher’s Clearing House. Most people though will just have to grin and bear it. And eventually they will die. That’s the ultimate denouement.

Republicans are supportive of the rich, the talented and those who can make it on their own. They don’t have much sympathy for poor people, especially poor and sick people. The poor and the sick, the lame and the halt, don’t deserve to be a part of country club earth. Republicans consider themselves to be the “best and the brightest.” They are the ones who need to be supported and encouraged, whose genes need to be transferred to the next generation. They are all about the improvement of the race.