Bye, Obamacare, You Sure Were Nice!

Nice while it lasted

We really liked having health insurance. And in fact, thanks to an employer who believes in radical socialist ideas like paying a living wage, we'll probably be able to afford it even when the R's repeal the Affordable Care Act and we return to the bad old health insurance "system" we had before. Or whatever "terrific" replacement the Trumpers will treat America to (you'll be able to buy cheap shitty insurance that covers virtually nothing, but do so across state lines, hooray!).

What sucks is that while we'll be OK -- probably -- the end of the ACA means  people will die.  Families will be more likely to go bankrupt after a health care crisis.

Depending on what rough beast slouches out of Congress onto President Trump's desk, we're likely to return to something like the patchwork of private insurance and a shredded safety net we had before, leaving insurance companies free to deny coverage for pre-existing conditions, limit your annual and lifetime coverage, and bounce young adults off their parents' plans at the age of 18. Oh, and to raise your rates as much as they want, because Free Market.

Hey, here's something to feel good about: Since Obamacare repeal will also roll back Medicaid expansion as well, there'll no longer be a gap between the ceiling of the expanded Medicaid income limit and the floor of the ACA subsidies, since both will vanish, and about 22 million people are likely to be left without health insurance. 

Don't worry, they can still go to an emergency room, at least until the R's repeal that law too. On the up side, people who are already living paycheck to paycheck will be encouraged to get health savings accounts!

Maybe a sane-ish, much-reduced version of some kind of safety net can be negotiated instead of an outright repeal -- there are some non-insane R's left in the Senate, and there's no telling what sort of coalition building could happen to save some scraps. But scraps will be the most we can hope for. Hell, the insurance industry may lobby to keep some remnant of the new subscriber base.

Here's a thought: We could take the original model for Obamacare from the Heritage Foundation, slap Trump's name on it, and have some R introduce it. Better than nothing. And in the meantime, the ACA remains in effect for a while. Get your policy renewed and hope for the best.

Long-term, we remain certain America will eventually get its health insurance shit together. We really can't afford not to, and while the election of Donald Trump may set us back, the system as it had been was not working, and going back to it -- with whatever scraps may be adjusted -- simply isn't sustainable. It took 20 years to get from the Clinton health plan's failure to the ACA. We can't let another 20 go by without a real fix. If you're of an optimistic cast of mind, which isn't easy today, we might even dare hope that two or four years of a terrible Trump administration might move us toward single-payer sooner than later. It's a fight we can't give up on. As they put it at Mother Jones:  Don't Mourn, Fight Like Hell. 

Before that, though, we're in for a rough slog: for the uninsured rate to go in the opposite direction from the last few years, a lot more people getting sicker, a lot more families going broke, a lot more people dying of preventable illnesses, and -- in a triumph for the Free Market -- a lot of healthcare costs going up. As in the glorious old days before the ACA, working poor folks won't be getting chronic illnesses taken care of through Medicaid or a subsidized private plan, they'll just get sicker and sicker until they have to go to the ER to be stabilized. Those costs will be passed on throughout the system, and people will wonder why the hell their insurance and healthcare costs have gone up, even with the end of Obamacare.

Have to wonder: Will TrumpCare cover how sick we'll get from winning all the time?

UPDATE: We received this note from an ACA navigator in Illinois, who says there's reason to hope the program will remain in place for 2017, since insurance companies run on calendar years. Here's some guidance a number of organizations in Illinois are using:

 The best thing consumers who are in need of health care can do is to enroll in the marketplace. Our elected officials need to understand that Americans value and need quality, affordable health care. 

If you enroll by December 15th, your coverage will begin January 1st. Navigators and assisters are available to talk with you about your options, compare plans and see if you qualify for financial help in paying for your health care.

[ Vox / MoJo ]