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2017-OCT to 2018-JUL. U.S.:
Feds will no longer defend key provisions
of the Affordable Care Act in court.
Some Democrats push "Medicare for All."
2017-OCT-12 to 16: President Trump attacks "Obamacare," and issues a false claim about it:
On OCT-12, he announced that subsidies for low income Obamacare users will be terminated. Senator Susan Collins (R-ME) said that this would threaten:
"... the ability of vulnerable people to receive health care."
President Trump claimed that the Affordable Care Act (ACA) no longer exists. Addressing a meeting of his Cabinet, he claimed:
"Obamacare is finished. It’s dead. It’s gone. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore."
In reality, Obamacare is still the law of the land. A sign-up period will run from 2017-NOV-01 to DEC-15 in most states. 2
Sadly, many uninsured people will probably interpret President Trump's statement literally, will not bother to try to enroll in Obamacare, and remain uninsured and vulnerable to untreated illness and death.
Jonathan Cohn, writing for Huffington Post, said:
"A critical mass of insurers has remained in the [ACA] program because, as of this year, their financials were finally improving and they could see the makings of the stable, profitable market that the law’s architects always envisioned. But that future was dependent on an administration that wanted the program to succeed. The Trump administration feels differently, and insurers will be thinking about that, hard, in the spring when they make their decisions about whether to stay in the program for 2019 and beyond. ..." 3
Trump has also reduced the ACA's advertising budget and the length of the signup interval, with the apparent intent of making his expectation of the death of the ACA into a self-fulfilling prophecy.
2017-OCT-12: President Trump terminates some important payments to health insurance companies:
These payments were paid to health insurers so that they could offer lower health care premiums under Obamacare for low and middle income customers. Insurance companies had expected to receive about $10 billion in payments during 2018. This will force companies to increase premiums. This will undoubtedly cause many customers to cancel their health insurance.
Chuck Schumer, (D-NY) issued three tweets on the same day:
- "Sadly, instead of working to lower health costs for Americans, it seems [that the President] ... will single handedly hike Americans’ health premiums."
- "It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America."
"Make no mistake about it, [the President] ... will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it." 4
2018-JUN-07: The Federal Justice Department announces that it will no longer defend important parts of the ACA (Affordable Care Act) in court:
Congress recently repealed that part of the ACA that fines individuals who have chosen to do without health care insurance coverage. In response, Texas and 19 other Republican-led state governments are suing the federal government. They claim that without this "individual mandate" payment, the entire ACA is unconstitutional. Meanwhile, California and some other Democrat-led states are defending the law in its original form.
One of the important functions of the Federal Justice Department is to defend all federal legislation whenever it is attacked in a court. On JUN-07, in a very unusual move, the Justice Department filed a brief in a Texas federal court announcing that they would no longer defend parts of the ACA, including:
- The ACA's "individual mandate" requirement that everyone be protected under a health care plan, and
- The requirement that insurance plans must cover all medical conditions.
Attorney General Jeff Sessions informed Congress that President Trump approved this withdrawal of support by the Justice Department.
The Trump administration agrees that -- by deleting the fine -- that part of the ACA that requires persons to have health insurance coverage is also unconstitutional. It, and other provisions should be removed. But they would like to retain that part of the ACA that covers the Medicaid expansion and retain some other parts of the law as well.
America’s Health Insurance Plans is a trade group organized by U.S. health insurance companies. They issued a statement saying that:
"Zeroing out the individual mandate penalty should not result in striking important consumer protections. Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019."
Lawyer Donald Verrilli Jr. once defended the ACA at the U.S. Supreme court during the Obama administration. He said that the Justice Department's policy is:
"... a sad moment. ... I find it impossible to believe that the many talented lawyers at the department could not come up with any arguments to defend the ACA’s insurance market reforms, which have made such a [positive] difference to millions of Americans."
I am certain that these "talented lawyers" are quite capable to reform the ACA. However, to create a path forward that Republicans and Democrats in Congress would accept is probably an impossible task.
2018-JUN-08: Federal Justice Department attacks still another aspect of health care in court:
Back before the Affordable Care Act (ACA) was passed, health insurance companies would often refuse to insure people with some ongoing medical conditions or recent illnesses. Often, when they did offer insurance plans to those with pre-existing medical conditions, they excluded coverage for those illnesses, and/or made the premiums extremely high -- beyond many people's ability to pay.
The Affordable Care Act made these practices illegal. This has been a very popular feature of the ACA. As many as 130 million adults in the U.S. have pre-existing conditions. Jen Christensen, writing for CNN, said:
"As many as one in two Americans has some kind of illness or condition that was, at one time, considered a pre-existing condition by insurance companies before Obamacare. For older Americans, that percentage is even higher: About 86% of your aging parents and grandparents, Americans between the ages of 55 and 64, have one, according to government estimates.
A Kaiser Family Foundation poll in mid-2017 found that 70% of U.S. adults favored the protection of people with pre-existing medical condition(s). They felt that:
"The federal government should continue to prohibit health insurance companies from charging people with pre-existing health conditions more for their coverage." 5
In contrast, the poll found that only 26% felt that individual:
"States should be able to decide whether insurers can charge people with pre-existing health conditions more if they don't have continuous coverage." 5
Nicholas Bagley, formerly a Justice Department lawyer and currently a professor at the University of Michigan Law School, said that DOJ's move is troubling. He said:
"The Justice Department has a long-standing, durable, bipartisan commitment to defend [all] acts of Congress. It's a cornerstone of what they do. For the Trump administration to crumple that up and throw it out the window is galling." 6
By refusing to defend the ACA in court, the Justice Department is increasing the probability that future health care protection of many, most, or all people with pre-existing conditions will vanish or be priced out of reach.
Polls have been showing that the ACA is a major concern among voters. As November's midterm elections approach, Democrats in Congress are focusing on this topic as a major election issue.
Erica Werner and Amy Goldstein, writing for the Washington Post, said:
"Now, the Justice Department’s stance in a federal-court case in Texas will allow Democrats to argue that Republicans want to deny affordable health coverage to some of the people who need it most. ..."
"The administration’s legal stance injects profound uncertainty into the political debate and the health-care landscape at a critical moment, just as insurance companies are developing rates for the coming year  and as candidates head into a summer campaign season that both parties will try to use to solidify a foothold for their agendas. ..."
"Republicans on Capitol Hill had no advance warning that the administration was going to assert that protections for people with preexisting conditions is unconstitutional — a position that defies President Trump’s promises to maintain those protections." 7
Rep. Leonard Lance (R-NJ) said:
"I certainly do not believe the provision on preexisting conditions is unconstitutional. I don’t even understand what the legal argument would be. I have always favored coverage for preexisting conditions and will continue to do so." 7
Larry Levitt, a senior vice president at the Kaiser Family Foundation said:
"This lawsuit is less about altering the law and more about blowing it up." 7
2018-JUL-20: Health care spending around the world:
Universal health care, a.k.a. single payer healthcare, national health care, etc., is the norm in most of the developed countries of the world, with the exception of the U.S. During 1912, Norway was the first to introduce such a plan, By 2014, the list of countries providing universal health care or mandated health care included Australia, Austria, Bahrain, Belgium, Brazil, Brunei, Canada, Chile, Czech Republic, Denmark, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Luxembourg, the Netherlands, New Zealand, Norway, Poland, Portugal, Singapore, Slovenia, South Korea, Spain, Sweden, Switzerland, Turkey, UK, and the United Arab Emirates. 8 Universal coverage is neither a rare nor a radical concept today.
The Canadian Institute for Health Information compared the average amount spent on health care per person using data supplied by the international Organisation for Economic Co-operation and Development (OECD) for 2015. They found that, in Canadian dollars (which are typically worth a little less than U.S. dollars):
The U.S. invested 16.9% of its GDP, or $11,916 per person per year in health care. This is the highest GDP percentage and per person cost of any of the nine countries listed.
The next highest cost was in Germany which invested 11.2% of its GDP and $6,709 per person in its universal plan.
Canada, the country whose society is probably closest to the U.S., invested 10.4% of its GDP and $5,782 per person in its universal plan.
New Zealand invested 9.3% of its GDP and $4,443 per person in its universal plan. This is the lowest percentage and per person cost of any of the nine countries listed. 9
Unless health care planners in the U.S. are totally incompetent, they should be able to introduce a universal health care plan there that will reduce per-person cost by 50% from its current value.
Meanwhile, in the United States, many employed individuals have health care provided by their employer. Other Americans purchase whatever healthcare they can afford, if any, and rely on emergency rooms to take up the slack. The end result is many preventable deaths across the country, and a shorter average life span in the U.S. compared to many other developed countries. A universal health care system would probably add a billion years to the total life span of today' Americans. Unfortunately, health care is currently run as a profit-making industry, not as a service provider. It generates immense profits to every component of the system, from medication suppliers to hospitals.
2018-JUL: Liberal Democrats form a House caucus to promote "Medicare for All:"
"Medicare for All" was proposed by Senator Bernie Sanders (I-VT) during his presidential campaign in 2016. He lost the election.
About 60 Democratic members of the federal House have formed a caucus to promote "Medicare for All." Medicare has an excellent reputation providing care for elderly people. It is a less scary term to many Americans than "universal health care" or "single-payer health care." The caucus has introduced a resolution to implement upgraded health care.
Rep. Debbie Dingell, (D-MI), a co-founder of the House caucus, said at a group meeting:
"If you live in America, you've got a right to affordable quality health care, period."
Perhaps everyone should have such care. But, in reality, they don't, and this is the problem.
House Majority Leader Kevin McCarthy, (R-CA) warned:
"It would break Medicare. And it would end any private insurance as we know it." 10
More developments are inevitable.
The following information sources were used to prepare and update the above
essay. The hyperlinks are not necessarily still active today.
Image rawpixel. Downloaded from the Unsplash web site.
Igor Bobic, "Trump Says There's 'No Such Thing As Obamacare Anymore' One Month Before Enrollment Starts," Huffington Post, 2017-OCT-16, at: https://www.huffingtonpost.com/
Jonathan Cohn, "Trump’s Latest Health Care Move Will Cause Pain, But Not For The Poor," Huffington Post, 2017-OCT-16, at: https://www.huffingtonpost.com/
"Obamacare bombshell: Trump kills key payments to health insurers," CNBC, 2017-OCT-12, at: https://www.cnbc.com/
"Kaiser Health Tracking Poll - June 2017: ACA, Replacement Plan, and Medicaid," Kaiser Family Foundation, 2017-JUN, at: https://www.kff.org/
Alison Kodjak & Susan Davis, "Trump Administration Move Imperils Pre-Existing Condition Protections," NPR/KPCC-FM Pasadena, CA, 2018-JUN-08, at: https://www.scpr.org/
Erica Werner and Amy Goldstein, " 'You’ve handed us an issue:' Democrats pounce on Trump administration’s health-care move," Washington Post, 2018-JUN-08, at: https://www.washingtonpost.com/
"List of Countries with Universal Healthcare," True Cost Blog, 2013-JAN-21, at: https://truecostblog.com/
"How does Canada’s health spending compare internationally?," Canadian Institute for Health Information, 2018, at: https://www.cihi.ca/
"Leftist Democrats pushing 'Medicare for All' election theme," One News Now, 2018-JUL-20, at: https://www.onenewsnow.com/
Copyright © 2017 and 2018 by Ontario Consultants on Religious Tolerance
Originally posted on: 2018-JUL-30
Author: B.A. Robinson