A few days later, Trump follows through and in a historic ceremony, affixes his John Hancock onto the repeal bill. Obamacare is no more.
The Republican Party engages in self-congratulatory praise and celebration. They have cured the country of the cancerous scourge that has been destroying the middle class from within.
Moments later, Sarah Jones, goes to the hospital hours for emergency care. She has just been hit by an automobile. Sam Smith walks into the reception area of the hospital for his much-needed and prayed for a kidney transplant. Liz Brady’s 8-year old son, Charles, has just been diagnosed with cancer. Bob Green goes to Dr. Harry for his routine diabetes checkup.
All of them are told their insurance companies have refused coverage. Thus, if they want treatment, they must pay out of pocket.
What? Are you kidding? How can this be, they all ask?
The response from the hospital and physician intake offices are sober, “sorry, you no longer have insurance”. The intake officials inform Bob that if he is able to get insurance for his long-time condition of diabetes, he still might not have coverage for his now long-term pre-existing condition. The insurance companies send out notices to all of its insureds—“sorry, when Congress nullified the Affordable Care Act, it ended all pre-existing conditions coverage which is no longer mandated by the law. Oh, and by the way, we can offer you a policy without pre-existing condition coverage, but it won’t include payment for any of your current conditions”.
Now, the promises made by Trump and Republican candidates for Congress and website like Breitbart, National Review, and so many others, that promised a new healthcare plan where you can keep your insurance coverage and your doctor, rings hollow.
Is this hypothetical scenario a scare tactic?
In my opinion, absolutely not. When those Republicans over the past half-decade voted to repeal Obamacare, it left a major hole in their attack against the revolutionary healthcare plan. They never provided an associated fix. In medical terms, they tried to stop the hemorrhaging, but in doing so, were never concerned about leaving the patient on life support.
As I have warned many times in the past, when a law is repealed, it suddenly ends. The legislation that the Republican House of Representatives has passed before without Senate concurrence or which this year, passed by Congress but vetoed by Obama, did not anticipate the reality of the future. It failed to account for the logical consequence, ending the law, ends the coverage or the benefits associated with the coverage passed by the law.
Which raises some really serious questions for insurance companies, states, doctors, patients and the federal government—what happens with Medicaid expansion? What happens with insurances that were not just purchased through the exchanges but bought privately and that now contain provisions such as annual or lifetime caps and yes, pre-existing conditions?
Also, what happens when states, like Louisiana, which have opted in for Medicaid expansion, insist that the federal government continue to pay for that coverage. The federal government, in turn, might respond and say “sorry, we are no longer required to do so. We have bigger problems now”.
Republicans, Donald Trump and many conservative lobbying organizations wanting to end Obamacare immediately have been totally irresponsible. They have vilified the law, have made promises such as “pulling Obamacare out by its roots on day one they take office”. They cannot keep any of those promises without immediately putting this country into chaos.
Obama, the Democrats, and others, including Hillary Clinton, have not been much better in articulating the risks. They have not made the case—exactly what would the world look like if Obamacare were to suddenly pass away.
The real problem has been so obvious--if a governmental body repeals a law, the provisions no longer exist. It is true that legislatures can set the repeal date to sometime in the future but, there is no guarantee that on that date certain there will be any solution or workable solution. And yes, certain provisions can be grandfathered in to guarantee the continuance of coverage. But, doing any of this will be a legislative and political challenge of the highest order.
Simply saying, Trump and the Republicans will fix it, is not enough.
For one did any of them uttered a single word about the risks of an immediate repeal without a legitimate replacement?
You can bet that insurance companies who were persuaded to pick up pre-existing conditions coverage because of the promise that they would have a pool of young healthy insureds to compensate for those older, unhealthier, won’t just roll over and play dead. They never wanted pre-existing coverage and no plan presented thus far by anybody has been widely accepted by the parties with an interest and who have skin in this healthcare game.
Finding a solution to undoing Obamacare might take forever. Simply passing legislation does not mean the solution will fix the problem, anyway.
The Affordable Care Act was a noble endeavor in trying to extend health care coverage to many, giving incentives to insurance companies to participate, reducing the risks of all involved and of course, providing coverage for pre-existing conditions.
Unfortunately, for many reasons, it is causing sizeable increases in insurance premiums for some and the insurance companies don’t want to participate as they are losing money. Of course, there are other issues too.
Yet the fury of resentment and opposition to the law has created a scenario of legislative malpractice. Those who have screamed and voted for immediate repeal without a real plan in place, are cutting off the head without any promise or hope of any replacement.
Ultimately, my guess is, whoever is in the White House and in Congress will realize that the best course in the immediate future is to try to fix the problems that do exist. If the Republicans gain control of the government, hopefully, they will realize they are committing suicide by their public proclamations of immediate repeal and replacement without any real plan for replacement. Hopefully, they will realize that fixing and ultimately replacing is the only legitimate way to proceed at this point.
On Wednesday, we will have some sense as to which way this country will go.
Let’s hope that whoever wins the Presidency and the US Senate, they will recognize they have misrepresented the solutions to the public or failed to diagnose the problem and legitimate fixes.