Commentary: Trumpcare: Health insurance for young, wealthy

There is a huge gap between the promise of Trumpcare and the reality.  President Trump promised better, lower-cost insurance available to everyone.  In reality, Trumpcare will cost many people much more and provide less.  It isn’t an exaggeration to say that millions of people in the country will lose their insurance, not by choice, but because they cannot afford it. Charity care cannot take its place. People will die because they aren’t rich enough to go out and buy good insurance without help.

Over the next few years, Trumpcare ends the expansion of Medicaid that provided coverage to about 11 million working poor.  It turns Medicaid itself into a block grant that provides states with a fixed amount per person instead of paying for a percentage of the cost of running the program. Those changes may sound insignificant, but they will have a huge impact.  The Congressional Budget Office estimates that the federal government will decrease its Medicaid spending by $880 billion dollars in the period from 2017 to 2026. As a result, 14 million Americans will lose coverage over the next 10 years.  For many with cancer, chronic illnesses, or sudden health crises, this is a death sentence.

The damage from changing Medicaid isn’t limited to what we think of as traditional health care.  Medicaid funds almost two-thirds of people in nursing homes. As the population gets older, more Americans will need Medicaid for long-term care services, but the funding won’t be there unless states fill in the gaps.

Trumpcare also eliminates the income-based subsidies that make insurance affordable for people with low incomes who are not eligible for Medicaid.  It substitutes an age-based tax credit ranging from $2,000 to $4,000.  At the same time, Trumpcare lets insurance companies charge older people five times as much as younger people.  AARP’s Public Policy Institute has estimated that a 55 year old earning $25,000 a year could see premiums go up by $3,600 a year. The news is even worse if you are poorer and older. At age 64, when the age penalty hits the hardest, someone earning $25,000 a year would pay $7,000 more in premiums, while someone earning $15,000 a year could see insurance premiums go up as much as $8,400. Think about that.  How many people with an income of $15,000 could possibly buy insurance?  The result:  More citizens without coverage and more people dying because they aren’t rich.

Republicans want to trim benefits such as maternity care, rehabilitation, drugs, and mental health to make policies less expensive.  Making insurance cheaper at the expense of providing the treatments and medications that sick people need is a bad trade off.  At a time when the United States already has shocking infant mortality rates, how many more women and newborns will die because they could not afford adequate maternity care? How many people with chronic health problems will die because they couldn’t afford their prescriptions?

You may think this doesn’t impact you.  You have employer paid insurance, so you are safe.  Think again.  The new health care bill does away with the requirement for large companies to provide coverage. Let that sink in.

Even if your policy is not affected, the health care system as a whole will feel the change.  Both the American Medical Association and the American Hospital Association oppose this plan.  When those who provide our care believe that a plan will damage health care and hurt patients, it is worth paying attention.

Is the Affordable Care Act perfect?  Of course it isn’t.  But hatred of Obama is hardly a good enough reason to sign a death warrant for thousands of people.  The notion that consumer choice and the free market should guide our health care system makes no sense if the consumer cannot afford what the market place is selling.  When Republicans in Congress and the administration find a way to provide good, affordable insurance to all Americans, I’ll be the first to applaud.  Until then, let’s call Trumpcare what it really is:  health insurance for the young and wealthy.  Everybody else may want to cross their fingers and pray to stay healthy.

Margret Straw is a Warren County resident.  Prior to retirement, she was a senior research fellow at AARP.