Until recently, the nation was making headway in providing health insurance for more people. The Trump administration, however, is doing its best to reverse that trend, and it’s costing us lives.
At the end of 2017, 28.9 million Americans under the age of 65 were without health insurance, a big improvement over 2010, when 48.6 million were uninsured, but the number of uninsured Americans is about to increase. The Congressional Budget Office projects that by the end of this year, 32.9 million people under the age of 65 will be uninsured. That number increases to 35.9 million in 2020 and 40.9 million in 2021.
This is big problem for reasons I’ll explain shortly. It exists because the Tax Cut and Jobs Act, passed in December 2017, eliminated the individual mandate that was part of the Affordable Care Act. In turn, fewer people enrolled, and premiums went up. Some enrollees, whose incomes increased, no longer qualified for government assistance and could not afford the premiums. In addition, federal funds were slashed for navigators, the people who assist enrollees with the application process.
What was the reason behind repealing the individual mandate and trying to scuttle the ACA in general? Expense. The CBO projected in November 2017 that repealing the individual mandate would save $338 billion between 2018 and 2027. But conservatives didn’t have a problem the following month giving up $1.5 trillion in tax revenue, benefitting mostly the top one percent.
“This is about freedom,” Sen. Rand Paul, R-Ky., stated in mid-2017, “whether we as Americans should be free to buy what kind of insurance we want. … And it’s about whether the individual knows best or government knows best.” With his income, Paul can afford all the autonomy and insurance he wants.
Beyond the cost, conservatives just don’t believe government should be involved in healthcare. As the Economist put it in a Dec. 11, 2016, publication, the ACA “is the sort of redistributive economics that is anathema” to Republican ideology.
Bad things happen when people don’t have health insurance. The Institute of Medicine estimated in 2002 that over 18,000 Americans between 25 and 64 die annually because of lack of health insurance. A study published in the American Journal of Public Health in 2009 found that nearly 45,000 people in the same age bracket died in 2005 for reasons associated with lack of health insurance and that the uninsured have a 40 percent increased risk of death.
Why the higher mortality rate? The uninsured are more likely to go without the healthcare they need. When they do seek care, they often go to an emergency department. They are less likely to have a usual source of healthcare and, consequently, don’t receive preventative care. Fortunately, these problems decrease when people become eligible for Medicare.
Here’s how David H. Gorski, surgical oncologist at the Karmanos Cancer Institute in Detroit, puts it: “I’ve seen more women than I can remember who waited far longer than they should have to see a doctor for their breast cancer because they couldn’t afford it. … when they finally do present, their tumors are larger, more difficult to treat, and more likely to kill them.”
While the Emergency Medical Treatment and Active Labor Act of 1986 requires hospitals to provide emergency treatment to anyone regardless of ability to pay, emergency rooms are designed to handle acute problems, not provide preventative care.
Because hospitals have to eat the costs associated with treatment provided under the EMTAL, the goal is to stabilize and transfer the patient. Gorski recalls his days as a surgery resident at a county hospital where they “used to joke about the Friday afternoon phone calls to transfer patients who had failed a wallet biopsy.”
Conservatives on Capitol Hill like to justify their position on principles of small government and personal autonomy. Such virtues come easily when you’re adequately insured and healthy.
[This post was published as an op-ed in The Columbus Dispatch on March 2, 2019.]
_________________________________
Jack D’Aurora writes for Considerthisbyjd.com
_________________________________________________
ShareMAR
About the Author: