In the wee hours of Jan 5th I heard the whimpers coming from my son’s room. It’s a sound that instantly rouses a mother from her bed, the call of a sick child. For the next several hours tell the dim dawn light filled our windows I tended to his shivers and sickness that are the clear signs of the flu. Finally as the fever broke he fell asleep. Like any mother I was concerned, monitoring the fever for signs of needing to go to the hospital. My relief when his fever broke should have allowed me to drift to sleep. Not this morning. I was aware that today was the day the new Congress could vote to begin the process of repealing the Affordable Care Act, Obama Care.
Like many Americans I depend on the reforms created by this historic law. When I left my job over a decade ago, to start my own small business, my income strained under the weight of COBRA premiums. Despite the cost, I was thankful to have coverage at all. I have a pre-existing condition, a form of Muscular Dystrophy called Myasthenia Gravis. Despite this diagnosis I am completely healthy and rarely go to the doctor.
COBRA, and extensions of COBRA allowed me to have comprehensive coverage for a few years. Once it expired I had limited options, insurance through the California’s High Risk Pool, or a handful of heath plans that were required to be offered under California law (HIPAA Individual Conversion Plans ), sold in the private market that allowed coverage of people with pre-existing conditions. Because both of these options primarily covered only individuals with pre-existing conditions they were horribly expensive and had limited coverage. Limited coverage meant many things including having a baby was not covered. I literally owe the birth of my son to Obama Care.
I am very aware of the impact of no, or limited health coverage, has on a family. As a child I spent more than ten years going to hundreds of doctors to find a diagnosis for my disability. My father was drowning in my medical bills. Our dining room became a medical billing office. My dad spent many evenings with piles of insurance paperwork spread across the table, sorting through box after box to see if this or that bill had been paid or if the insurance company had reimbursed us. We had insurance and yet were in a constant financial crisis. My family was underinsured long before the health policy community became aware of the problem. Whenever my parents argued about money, I thought it was my fault. I once overheard my father lament, “If it weren’t for all her medical bills, we would be okay.” I worried that my health problems was resulting in my family going hungry.
Depending on who you are and your needs, you will likely have a different view of how your access to, quality of, and cost of health care, has improved or become worsened since the passage Affordable Care Act, Obama Care.
Your experience is impacted by the Iron Triangle of Health Care, three components, access, cost, and quality, that are interrelated whereas you attempt to change one and you impact the others.
You can make the health care system cheaper (improve cost), but that can happen only if I you reduce access in some way or reduce quality. You can improve quality, but that will either result in increased costs or reduced access.
Anyone who tells you that they care provide health care for everyone, improve quality, and also reduce costs is in denial or misleading you. So how do you judge if the Trump Administration will make Health Care Great Again? A way to judge the plans is how much they ignore the Iron Triangle. If they want to cut costs, that’s fine, but if they propose to do it without decreasing access or decreasing quality, unlikely.
The Trump Administration will likely be based on prior Republican’s proposals including House speaker Paul Ryan’s, “A Better Way” proposal, which seeks to reduce spending on the three core pillars of health care in the US.
- Health Insurance: Changes to Obama Care will likely reduce or eliminate coverage for millions of Americans. One estimate, by the RAND Corp., suggests it will eliminate coverage for 16 million people, with a particularly tough impact on people with serious medical conditions who would face higher out-of-pocket charges.
- Medicaid: State’s provide access to health care for millions of low income American’s and provides critical access to long-term care services for seniors and people with disabilities. State’s ability to provide these services is dependent on financial support by the federal government. If federal support is reduced it is likely State’s will eliminate many benefits and eliminate coverage for 25 million American’s. The Children’s Health Insurance Program (CHIP), which provides health care coverage for children from low-income families also comes up for reauthorization in 2017, and Trump opposition could end CHIP, potentially leaving 8.4 million children without coverage.
- Medicare: Is a single-payer, national social insurance program, administered by the federal government since 1966. Medicare guarantees health coverage at a certain level with additional coverage purchased through supplemental insurance. The government contracts with private insurance companies to administer the program. In 2015, Medicare provided health insurance for over 55 million—46 million people age 65 and older and nine million younger people with disabilities. In order to get access to Medicare you had to have worked and pay money into the social security system. Speaker Paul Ryan’s plan would create, “premium support” system, under which each senior would get a fixed amount of money, a voucher, to purchase health insurance. While it is not clear the full impact of Speaker Ryan’s plan, but he is likely to raise the age of eligibility and potentially increase costs for many seniors, particularly those with chronic health conditions.
Let’s send a message to President Trump and Congress that health care is an Iron Triangle –don’t ignore the health and welfare of millions of Americans just to save money.