preexisting condition — Blog — The Patient Advocate's Chronicle

I’ve been planning a legislative update for a while. Little did I know just how bad June 2018 would be.

Before yesterday, I might have spent the whole post talking about the Trump administration’s new policy that allows insurance companies to offer plans that do not cover the 10 essential health benefits guaranteed by the Affordable Care Act. Of course, the ultimate target of the policy is to completely eliminate mandatory protections for those with pre-existing conditions, even though protecting that particular essential health benefit is “very important” to over 70% of Americans. Or perhaps the proposed cuts to the medical safety net – Medicare and Medicaid -- that would affect our most vulnerable, justified by a tax cut that was bad, but not that bad until you realize that they needed it to create a reason to gut Medicare and Medicaid.

I would have encouraged you to vote if you felt threatened by these policies. I would have given you a link to make sure you were registered (and to register if you weren’t), tell you where to go on election day, and how to vote early, as well as one to help you evaluate the candidates by their voting records.

And I would have steered clear of anything political beyond healthcare policy.

In good conscience, I can’t do that anymore. I will always encourage you to vote, but the Supreme Court has handed down three decisions in the last three weeks that will make that more difficult.

Decision #1: Gerrymandering is a way to draw (or re-draw) Congressional districts in a way that discriminates against members of a specific race/ethnicity or political party. Racial gerrymandering has been illegal for a long time. Until recently, political gerrymandering was not egregious enough to require laws to prevent it. Now it is. A couple of weeks ago, The justices decided that they weren’t going to rule on whether partisan gerrymandering is unconstitutional. It’s hard, but not impossible, to measure, and it’s gotten to the point where it is demonstrably creating an unlevel playing field. This would have been the time to act. Solution: Get your state legislature to put gerrymandering on the ballot. Several states are proposing plans for the courts or bipartisan commissions to redraw the districts. Twenty-four states allow citizens to propose policy to the legislature or directly to their fellow voters.
Decision #2: They upheld a decision to continue letting Ohio to purge voter rolls after missing one vote. Currently, if you miss a presidential or mid-term vote, the state will send you a notice informing you that you are about to be purged from the voter rolls. On paper. Through the mail. If you do not respond, you will be taken off the voter rolls after another four years. Do you know who actually checks the mail and reads random communiques from the state? No one under the age of 60. The Voter Registration Act says purging voter rolls for not voting is illegal. However, the majority (strictly along party lines) ruled that because the purge wasn’t aimed at a single individual, it didn’t violate the law. Do not let yourself believe that this behavior will be confined to Ohio. Solution: Nothing for the moment.
Decision #3: They reversed a lower court decision that Texas districts were racially gerrymandered against Latinos. This decision was also made along party lines, and comes five years after they gutted the Voting Rights Act. Solution: Nothing for the moment.

All of these things put together with states closing polling places in minority neighborhoods, voter ID laws, and limiting polling hours and early voting options conspire to make voting by certain groups impossible. And who are these groups? Minorities, low-income earners, the elderly, and the disabled. All we ever wanted was a level playing field, and each of these things is another obstacle to overcome for the people who have the most to lose.

I am an optimist. I do not like being the doomsayer, but today it feels like there is no other choice. Today, Supreme Court Justice Anthony Kennedy, the only swing vote on the Court, announced that he will retire at the end of July. I can tell you right now that the Trump administration will nominate another Neal Gorsuch, who believes that racial gerrymandering is not illegal and has indicated through his judicial record that he does not believe in legal protections for the disabled. The Supreme Court protected the ACA only because the individual mandate was a tax. Now that the individual mandate is gone, so is the reason the Supreme Court protected it. What do you think will happen when the Trump administration brings another case saying that the Affordable Care Act is unconstitutional now that the individual mandate is gone. Nothing good, I assure you.

Supreme Court appointments are for life. Whoever comes in after Kennedy will be there for decades. The only way to stop it is to flip the Senate from red to blue – another very difficult but not impossible task. This means we have to protect Democratic Senators in Florida, Indiana, Missouri, North Dakota, and West Virginia, and flip two in Nevada, Arizona, or Tennessee.

I can tell you right now: this is the most important vote you will ever cast. If you have to miss an hour or two of wages you can hardly afford, or bring your kids to the polling place with you, or beg a ride to get to your polling place, PLEASE VOTE, especially if you live in one of the states I mentioned above. If you ever felt powerless in politics, now is your time. We have the power to protect ourselves, if only there are enough of us. I do not want to see our rights, so dearly won, steadily walked back for the next 30 years, and neither do you.

P.S. I do not consider the current administration to be conservatives. They are not the respected adversaries I have always known.

NOTE: The Affordable Care Act is often referred to as Obamacare. They are the same Act.

More often than not, when a bill dies in Congress (or is withdrawn due to lack of support), it is not revived until the next Congress. (There is a new Congress every two years.) However, healthcare reform is a big enough priority for the White House and Congressional Republicans that it appears lawmakers will continue to negotiate with various caucuses to find a passable solution as soon as possible.

Recently, after negotiations between moderate and conservative Republicans in the House, an amendment to Paul Ryan’s American Health Care Act was offered. The amendment would keep all of the Essential Health Benefits and several other provisions of the Affordable Care Act, but allow states to opt out of coverage if they could prove that opting out would keep consumer costs down, cover more people, or if it would be in “the public interest of the state.” There is no specific definition of what is considered “the public interest of the state.” Secretary of Health and Human Services Tom Price would be responsible for approving or denying state waiver requests.

How could the amendment affect you?

With a waiver in hand, a state could get rid of the protections for people with preexisting conditions by establishing high-risk pools. A high-risk pool is exactly what it sounds like: everyone considered a high-risk/high-cost patient is grouped together under less-than-favorable insurance policies. According to a 2015 analysis by the Commonwealth Fund, high-risk pools would do exactly what Obamacare was trying to prevent: increase costs to the population with the highest medical bills and/or severely limit the coverage offered to those in the high-risk pool.

High-risk pools are not new to health insurance markets. The Affordable Care Act banned high-risk pools, but before that, they were used in 35 states and as a stop-gap measure between the passage of the Act and when it went into effect. Evidence from previous high-risk pools supports findings that state-based programs, while charging high-risk patients up to 250% more than healthy patients, came with insanely high premiums and out-of-pocket maximums.

The government knows it would have to fund states’ high-risk pools. Currently, they plan to offer subsidies totaling $25 billion over 10 years. However, independent estimates place the figure needed to fully fund the pools at $178 billion. In order to control consumer costs at all, coverage offered to high-risk patients might be whittled down to nearly nothing at all.

There are documented cases of patients in high-risk pools paying $18,000 and $25,000 premiums, even with limited coverage. According to the Center for American Progress, I could pay an additional $5,600/year. Even people with mild asthma could pay over $4,000 more than they do now. Patients with certain kinds of cancer could end up paying over $142,000 more, and pregnancy could cost up to $17,320 more.

What does this mean in practical terms?

The numbers are good to know, but they're cold. I started this blog hoping that eventually, I would be able to support myself with it. If the above reforms pass, that will become much more difficult. Finding an individual health insurance plan that will cover a diabetic woman who already has complications would be next to impossible for states with waivers, and if I do find one, it will be prohibitively expensive.

Will we have to choose which meds we can afford? Will we have to forego the best treatment because insurance policies are no longer required to cover it?

The good news is, we can do more than just keep our heads above water. We can swim. Only 17% of Americans approve this plan (poll was taken before the amendment, which doesn't actually change anything in the bill), which is a number so low, the remaining 83% surely includes a majority of healthy people. A smart Senator or Congressman won't vote for a bill that is so unpopular in their district. However, to be on the safe side, we might want to make sure our lawmakers know how we feel about it.

Find the people who represent you in Congress and make a phone call. It's a right guaranteed by the First Amendment (petitioning the government for the redress of grievances), and you may be surprised how effective it can be.