2017-05-04 – Well, they did it. They passed their anti-Obamacare bill. You better hope that the Senate stops this train wreck because here are some of the things that the GOP bill does:

• Encourages People to Drop Out of the System. Obamacare requires everyone to be covered by health insurance. This is enforced by a tax penalty on people who are not covered. This is called the individual mandate. Republicans hate this (except that Republicans loved it before Obama adopted the concept—but that’s another story). Under the GOP bill, if you are not covered. Cool. If you are not covered and you suddenly think you might need coverage, you just pay a 30% surcharge for a year. Tons of people, especially young people, will take the chance on this. Couple this with a reduction of the subsidy for the same people and the result is predictable.
• Premiums Will Go Up and Up. The result of these two new provisions—end to the individual mandate and reduction of the premium subsidy means that the insured pool will be older and sicker. States will be able to mitigate this somewhat by allowing age differentials in premiums. Older folks will pay more. Younger folks will pay less. But remember, the subsidy is cut. You think premiums went up under Obamacare? You ain’t seen nothing. Premiums will go up and up. People won’t be able to afford them.
• Preexisting Conditions. If you have any kind of condition, you better hold on to your insurance. Because if anything happens, if you lose your job and your employer’s health care plan, if you have any gap in coverage, you are shit out of luck. That probably covers 25% of the nation. If you count families, probably half the families have someone who has a preexisting condition. Maybe more. The GOP was chicken on this one. They didn’t have the courage to destroy this protection at the federal level, so they punted it to the states. The states can authorize insurers to kick you to the street like a dog if you have a preexisting condition. The only restriction is that the state must set up a high-risk pool. Congress is appropriating $8 billion to cover that. Remember that 25% of the population has preexisting conditions. $8 billion will cover your parking while you go for your MRI—nothing more.
• Employer Plans Could Lose Protections. When we talk about Obamacare, we tend to think of the individual insurance market. But employer plans were affected by rules that define the minimally acceptable set of coverages that must be in every health insurance plan. Obamacare prohibited lifetime caps which yank coverage from people who are really sick. Obamacare prohibited preexisting condition exclusions for employer plans as well as individual plans. And so on. States are given the right to fiddle with these things. A state like California might stick to the Obamacare rules, but many states are under the control of hard-right ideologues. If you are in a state like that, you better worry about your employer-provided coverage.
• Medicaid Is Cut. And you better be healthy enough to work, because states can impose work requirements as a condition of coverage. But don’t worry, under the Americans with Disability Act, employers are required to make accommodations if you have something wrong with you. So you’ll be able to wear your IV as you greet customers at Walmart.
• State Waivers. I’ve mentioned this a couple of times now. States can allow higher premiums for old people. States can eliminate the prohibition against preexisting condition exclusions. States can impose work requirements on Medicaid. Etc. You probably can guess which states are going to take these anti-Obamacare measures. They are probably the same states that refused the Obamacare expansion of Medicaid. Your healthcare is going to depend on where you live more than ever. The irony is that, under the GOP bill, the worst of the worst will happen in states that supported Donald Trump. Let me say that again: The worst of the worst will happen in states that supported Donald Trump. WTF!
• Congress has Exempted itself from this Awfulness.

That’s enough. I can’t go any further.

My representative in Congress voted against this bill. My senators will vote against it when it comes to the Senate. Trump promised that everyone would be covered, that the coverage would be better, and that the whole thing would be a lot cheaper. This bill reduces coverage, makes coverage worse, and will drive a big spike in premiums.

People will die.

So get your Senators to vote no.

And get busy working to defeat the GOP jerks who voted for this abomination. Paul Ryan’s district is about an hour’s drive from my house.

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