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Posted on Mar 18, 2017

Column: ‘Trumpcare’ is not the way forward

By Sandy Zavala, columnist

The results are in. Trumpcare is not better than Obamacare. Your health is not an option. Nor is it a luxury you can go without. As the American Health Care Act, or Trumpcare, is being peddled to the American people, this fundamental right is at risk. The Affordable Care Act, commonly referred to as Obamacare, is not without flaw, but the hastily erected Republican replacement is not the solution.
According to the Congressional Budget Office, by 2026, 52 million Americans would be uninsured under Trumpcare compared to 28 million under Obamacare. The fact that the federal deficit would be reduced by $337 billion on the backs of the 24 million uninsured is not a consolation. Although these numbers are estimates, they nonetheless provide a snapshot of a profoundly inferior replacement to current legislation.
According to Washington state’s Office of Financial Management, 14.8 percent of Grant County residents aged 19 to 64 have benefited from the implementation of Obamacare. Our North Central region, one of 10 legislative health regions, has the third-highest newly insured population in Washington state under the ACA’s Medicaid expansion provision. Gene Balk of the Seattle Times points out that rural areas like our own, which possess the highest mortality rates for individuals under the age of 65 when compared to urban areas, would be hit hardest by a Medicaid rollback. Daniel Lessler, chief medical officer at Washington State Health Care Authority, supports ongoing sustainable Medicaid expansion, explaining, “… We have studied the impact of gaining Medicaid coverage on health outcomes. Health outcomes improve and mortality goes down.”
The individual insurance market under Obamacare has also improved. Data from the Washington State Insurance Commissioner’s Office demonstrates that average premiums rose just 6.7 percent in 2015-2016, down from the 18.5 percent increase seen from 2008-2010. Even though some patients saw their premiums increase under Obamacare, premium averages before the Affordable Care Act were considerably higher. Costs invariably inflate when insurance companies insert themselves into the health care equation between the consumer and their provider. Blame premium increases on the insurance middlemen, not Obamacare, that block access to quality, cost-effective health care.
Let’s look at how Trumpcare differs from Obamacare. Those patients with pre-existing conditions will continue to receive health care coverage. Age- and income-based refundable tax credits will be issued to offset purchasing health insurance through the individual market. The AHA will phase out Medicaid’s enhanced federal match by 2020 while restructuring Medicaid funding. Under Trumpcare, insurers can impose a 30 percent surcharge on consumers that allow their policies to lapse. Families that find themselves in the unfortunate position of having to choose between paying for an expensive health care policy or more emergent needs will be forced to let coverage lapse.
Perhaps the truest indicator of where our president’s health care reform priorities lie, is that Trumpcare will lower taxes for wealthy consumers, pharmaceutical giants and insurance behemoths alike. The CBO estimates that wealthy individuals and corporate interests will pay 900 billion less in taxes.
To no avail, insurers plan to offer limited coverage policies at lower price points to slow the critical bleed of poor consumers. Under Trumpcare, the rich get richer and the poor get sicker. Nancy LeaMond, AARP executive vice president of social impact, issued the following statement: “AARP opposes this legislation, as introduced, that would weaken Medicare … Before people even reach retirement age, big insurance companies could be allowed to charge them an age tax that adds up to thousands of dollars more per year. Older Americans need affordable health care services and prescriptions. This plan goes in the opposite direction, increasing insurance premiums for older Americans and not doing anything to lower drug costs. On top of the hefty premium increase for consumers, big drug companies and other special interests get a sweetheart deal.”
A recently released report from S&P Global, an analytics think tank, echoes LeaMond’s concern, estimating that health care premiums for a 64-year-old would soar by 30 percent to $13,125 per year. Even after applying the $4,000 tax credit assigned to this age group, the cost is barely reduced by 30 percent. Seniors on a fixed income cannot afford to pay hefty monthly insurance premiums up front to only be partially reimbursed at a later date by a paltry IRS tax refund. At the same time, health care premiums for 21-year-olds will drop by 20 percent to $2,625 per year. Apply the $2,000 tax credit to that age category and young people receive a 75 percent discount under Trumpcare. S&P Global emphasizes that the insufficient tax credits for middle-aged individuals and Medicaid cuts will cause millions to lose health care coverage. Older Americans younger than retirement age may be forced to select bare-bones policies that only cover catastrophic health care costs, or go without insurance, because they cannot afford full coverage at higher rates.
Andrew W. Gurman, M.D., president of the American Medical Association, opposing AHCA, states, “The AMA supported health system reform legislation in 2010 because it was a significant improvement on the status quo at the time; and although it was imperfect, we continue to embrace its primary goal – making high-quality, affordable health coverage accessible to all Americans. As drafted, the AHCA would result in millions of Americans losing coverage and benefits. By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensive – if not out of reach – for poor and sick Americans. For these reasons, the AMA cannot support the AHCA as it is currently written.”
If organizations as politically divergent as AARP and the American Medical Association both recognize the shortcomings of Trumpcare, shouldn’t we consider the facts? Real facts, hard numbers, analyzed by reputable nonpartisan think tanks should provide the tangible foundation from which to repair Obamacare, not alternative facts that fuel baseless conspiracy fallacies. Contrary to the hysterical propaganda put forth by dubious news sources, a monster does not lurk under every bed. Lesson: Numbers don’t lie, people do, when seeking to manipulate the truth towards malignant nihilism.
Gov. Jay Inslee, in an interview with Q13 Fox News stated, “Health care is a right, health care is a reality, health care is improving in the state of Washington. Seven hundred fifty thousand Washingtonians are involved in this battle … Washington state people deserve health care.” Most of us, liberal and conservative, can agree on that.

Sandy Zavala is a former health care researcher, counselor and social worker. She lives in Quincy with her family.

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