There are rational debates to be had about our six-year-old health law, but we’re not having them.
The debate over our six-year-old national health reform law is quickly being defined not as right vs. left, or Republican vs. Democrat, but as decent vs. indecent.
That’s a harsh assessment, no doubt, and one that we don’ t make lightly.
But the push for a hasty, ill-considered repeal of the Affordable Care Act has come almost completely unmoored from reasonable objections to the way the law has worked, or hopes to improve its advances.
This now appears to be about not much more than striking back at President Barack Obama for having championed the law in the first place, and turning the nation’s back on the most vulnerable — people who were helped by the ACA’s progressive accomplishments.
How else to explain the rush to end federal subsidies for Medicaid expansion, which have led to tens of millions of Americans gaining insurance coverage for the first time?
There are perfectly rational debates to be had over whether Medicaid was the best vehicle for expanded coverage for the poor. There are many other arguments to be had about whether a government mechanism or market-based solution might have been better.
But the bill that passed the House on Thursday reaches none of those deliberative points, and merely sets the clock running on a return to the days when the poorest Americans chose between health care and shelter or food, to the times when people without coverage faced bankruptcy or other financial ruin if they or their family members got sick.
That’s not just sloppy — it’s incredibly irresponsible.
Same with the haphazard way the new legislation deals with securing insurance for Americans with pre-existing conditions.
This week saw an incredible turn in the public debate over that issue, as the comedian Jimmy Kimmel shared on his late-night show a story about his own infant son’s life-threatening, congenital condition — which, before ACA, could have caused many families to lose their insurance.
Kimmel appealed to politicians, regardless of party, to be not only reasonable, but compassionate in the way they pursue changes to ACA.
The most prominent response?
Republican Rep. Mo Brooks of Missouri crowed that the bill under consideration would “allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool… thereby reducing the cost to those people who lead good lives.”
It’s a crass and soulless prism through which to view the health care divide in this nation. It’s a perverse corollary to the idea that people who fastidiously guard their health should be rewarded. Now, thanks to GOP thinking, we may also be able to punish the unhealthy, because, well, their misfortune is clearly their own fault.
The bill on the table in Washington plays a twisted, immoral game with the issue of pre-existing conditions. Nominally, it continues protections. But it also gives states an out — if they can prove that sick people are contributing to high costs, they can charge them more. Which could, of course, lead to insurance simply being unaffordable for people with pre-existing conditions, rather than literally unattainable.
Yes indeed — money over people. That’s the way to improve a health care system that already spends more per capita than any other country in the world, but produces mediocre outcomes and, until ACA, left 40 million people to fend for themselves.
The cruelty of the current reform effort was undoubtedly the impetus behind Michigan Rep. Fred Upton’s announcement earlier this week that he wouldn’t vote for the Republican plan. On Wednesday, after a meeting with President Trump, Upton emerged and said he had secured enough assurance — an $8-billion addition to the bill to cover people with pre-existing conditions — that he was now a «yes» on the legislation. And that’s how he voted Thursday.
The GOP ranks appear increasingly crowded with members who believe poor people are to blame for their circumstances, and that the rest of us can somehow thrive while pushing them further into poverty. That’s not just wrong as an economic imperative — uninsured poor people actually cost the system more than when they are covered — but it is deadly wrong as a moral construct. The callous and selfish nature of bare-knuckled, every-person-for-themselves policy has never been more accepted by the GOP’s rank-and-file. It’s ironic as all get out, too, because the beneficiaries of the ACA’s expanded coverage are not just Democrats.
Reporting by Bridge Magazine recently detailed just how many Michigan residents in places that went heavily Republican are covered now by Medicaid, including Cheboygan County, where the number is 13%.
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The GOP spent six years assailing the ACA in the most simplistic terms, because there was essentially a free pass; Obama would never have signed the changes the party sought. Trump will, so someone has to speak on behalf of decency, of not throwing the most vulnerable among us back under the health care bus.
The ACA’s deepest problems have to do with the market side of it, where premiums have skyrocketed for many and where some employers have pulled away from providing employee coverage because of those costs.
Given enough time and the right framework for the discussion, there’s little doubt that solutions to those issues can be found — solutions that do not ease the burden for those who have by increasing the burden for those who do not.
Upton knows this. So do the other Republicans who have pushed back against this legislation, even if they are now mouthing support.
Stephen Henderson is editorial page editor of The Detroit Free Press, where this column first appeared. Follow him on Twitter: @shendersonfreep
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