Katy Burns: Goodbye, Obamacare; we hardly knew ye

  • President Barack Obama signs the Affordable Care Act in the East Room of the White House in Washington on March 23, 2010. AP

Monitor columnist
Published: 7/23/2017 12:25:06 AM

Repeal! Repeal and Replace! Repeal only! Repeal and replace later! Just let Obamacare die! Better yet, help Obamacare die! And don’t even bother replacing!

If the contradictory tweetstorms emanating from the White House are making you dizzy, it’s nothing compared with the head-twirling afflicting even hardened veterans of our nation’s Capitol. They don’t know what’s going to happen. We sure don’t know.

And I strongly suspect that the Tweeter-in-Chief himself – who has never shown a glimmering of knowledge about the various health care bills he’s endorsing and condemning almost daily – doesn’t know what’s going to happen either. Nor, I suspect, does he care.

All he really seems to want is something – anything – he can showily affix his laboriously practiced signature to and display to the world. Actual health care? Pffft!

And that’s fine with the GOP, which isn’t really into health care either, except as something (specifically Medicaid, one of the country’s most used and popular health care programs) to slash in order to finance massive tax cuts for the rich.

Whatever else you can say about Republicans, they are sure steadfast and single-minded about tax cuts as their holy grail.

So this would seem to be as good a time as any to check out what’s actually in the much-maligned Affordable Care Act. At least we’ll all know what Trump and the congressional Republicans want to take away.

The biggest, of course, is affordable access to health care, which the ACA gave to many millions of hard-working Americans for the first time. The Congressional Budget Office – and it is, yes, nonpartisan and generally more accurate than almost any other analytical organization – estimates that the various iterations of GOP “replacement” plans will mean 20 million to 24 million people will lose their health insurance. The losses would be even greater with repeal only.

You already know the big, popular things folks stand to lose. Like keeping 20-somethings on their folks’ medical insurance until they hit age 26 and have a decent bank balance – a big hit. Making insurers cover pre-existing conditions – a bigger hit.

Another important benefit we’ve focused on in the recent few years is the fact that it helps to bring medical help to people snarled in the opioid-addiction nightmare. New Hampshire would be a big-time loser.

But there are a host of lesser-known but valuable benefits of the ACA, a.k.a. the dread Obamacare. Many directly benefit the very people now pushing for the law’s repeal.

It mandates that all insurance policies include 10 essential health benefits, including preventive visits, mental health treatment (including substance abuse and addiction), maternity and newborn care, diagnostic lab tests, emergency room services and hospitalization. Amazingly, a lot of “health insurance” prior to the Affordable Care Act excluded hospitalization! And many “policies” were essentially junk – which their holders would only discover when they actually got sick.

Insurance companies now, by law, can’t spend more than 20 percent (15 percent in large group markets) of their premium dollars on overhead, promotion and profits. Before, the sky was the limit, and a lot of them went for that sky.

Under Obamacare, companies can no longer cancel policies if policyholders get sick. Nor can they put yearly or lifetime limits on total claim amounts. In the past, it was not uncommon for a severely handicapped child to hit his or her lifetime limit while barely out of infancy!

Medicare recipients may not know it, but they’re beneficiaries of the ACA. They are entitled to annual “wellness” visits. And the awful “donut hole” – a quirk in the popular drug reimbursement benefit that forced Medicare patients at times to bear the full cost of their drugs – is shrinking, thanks to automatic drug subsidies offered by Obamacare, and it will soon disappear altogether.

But if Obamacare goes away, that donut hole comes back.

And the ACA, for the first time, requires that nursing home employees undergo background checks, something of vital importance to older Americans in particular.

The ACA has brought menu labels with nutritional information. It provides basic services – including physical and occupational therapy and speech-language pathology – for people with disabilities.

Thanks to the law, health plans must include breast pumps and coverage for breastfeeding for new mothers, and employers must offer them reasonable accommodations (not bathrooms). And it vastly improved drug coverage under all insurance plans, improving the ability of doctors to prescribe appropriate meds.

In the time Obamacare has been in effect, it has promoted the use of electronic medical records, allowing a patient’s health care providers to share information about diagnoses and treatments, driving the way to integrated care and lessening medical miscommunications that can have dire consequences.

It’s promoted the payment to hospitals based on patients’ results rather than the number of individual procedures and tests administered.

The ACA – Obamacare – also funds scholarships and loans aimed at dramatically increasing the number of health care providers.

Is the ACA perfect? Of course not. But it’s a start on a saner, less expensive health care system. Have costs continued to rise? Yes, but the rate of increase – as determined by statisticians a lot more sophisticated than I – has slowed, an important beginning.

And there are any number of changes to the ACA that would and could continue us on a path to overall reform – if respective parties can come out of their corners and work together.

Our hyperbolic president has become fond of promising to “end the nightmare of Obamacare.”

But if the Affordable Care Act is in fact simply ended, the nightmare will only be starting for millions and millions of Americans.

(“Monitor” columnist Katy Burns lives in Bow.)

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