For some reason I found myself strangely drawn to listening to Donald Trump lie, twist, spin and pivot his way through today’s news conference. He’s totally bonkers about things like Russia, email, foreign policy. I mean, the wheels totally fell off his wagon and I’m sure there are more than a few diaries about that; so, I’ll focus on my wheelhouse. Since I work health care, it was his remarks on the Affordable Care Act that were of particular interest to me.
Most people around here really like the Affordable Care Act. No, it isn’t perfect, but it improved the lot for over 20-40 million people...possibly as many as 100 million or so depending upon your outlook. This idea of repealing the ACA has been around for 6 years, but most people think of it in the abstract. In order to show what a crack pot Trump is on most policy issues, you have to bring it home to the people you talk with about policy. Make it personal. Use personal examples. Show how repealing the ACA will screw them up.
I’ll start with my brother a “Jeffersonian constitutionalist” (whatever that means). He’s never liked the ACA, he’s religiously observant, but not currently a member of any specific congregation (yeah, there’s another diary there, too). Anyway, he is upset that his insurance since “Obamacare” has gone up and up and up. He’s upset that his deductible that was $1,500 a year in 2010 is now around $5,000. He’s upset that his premium dollars are going toward birth control for other plan members, when he and his wife don’t need that coverage and on and on he goes.
IMO we aren’t going to win the “Obamacare” argument if we don’t make it personal to everyone we talk with about the ACA. I zeroed in on him:
“Well, sure we can repeal the ACA in toto and when that happens we’ll fall back to the HIPAA specified restrictions on pre-existing conditions. You and your wife will have to pay out of pocket for the 6 or so drugs you both take for your chronic conditions. And if cancer comes up for your wife; your policy will likely have a monthly and annual cap on what they will pay for your care. BTW, the new chemo drugs routinely cost around $120,000 for a course of treatment. But, sure we can repeal Obamacare.”
“No. No. I like the pre-existing condition stuff and getting rid of the coverage caps is good, too (his wife is a medical transcriptionist, so he’s up on the medical lingo). We can keep that. It’s the mandate, I’m complaining about. I don’t like the government requiring I prove I have health insurance. That’s unAmerican. I don’t think it’s 6 drugs..it’s more like 5. How much does Crestor cost?”
“About $285 a month for one of you. You could ask your doctor to switch you to Zocor, that’s about $8 a month.”
“Well, I don’t think we need to go that far in repealing Obamacare. We can keep the parts we like…...”
“Well, it won’t work that way. If Trumps wins and the Senate and House stay GOP; it will be a full repeal. You will have pre-existing conditions and will go bare for your pre-existing conditions for 2 years.”
And that gave him food for thought. ...And , he took a deep breath in a wind up and said something that floors me,
“Now, you know I’m not going to vote for Donald Trump. I can’t vote for Hillary either. I’m either going to vote for Johnson or write in Mickey Mouse.”
Well, Ok. I’ll take it.
I had a similar conversation with a co-worker who was upset her son’s new job is with a small company that doesn’t offer health insurance and COBRA from his old job was more than double his payroll deduction.
“Well, your son had a qualifying life event. He can go with COBRA, shop on the exchange or you could put him on your insurance. He’s only 22.”
“Oh, yeah! I can do that! That’s a great idea. I wonder which will be cheaper? You, know i don’t like that law, but I forgot about this. …..” She paused, then asked, “Do you think I’ll be able to keep him on my policy next year?”
“If Clinton wins, yes. If Trump wins, no telling; that guy is as stable as tea cup set on a beach ball. He talks about repealing the whole thing.”
She replied in a (IMO) delusional vein, “Oh, I think they could keep that part of the law intact. They don’t have to repeal the whole thing.”
“That’s not how it works. The GOP has repealed the ACA in it’s entirety something like 46 times and it hasn’t made it through the Senate. But, if Trump wins and the House and Senate stay in GOP control; it will be repealed and I have no reason to believe they will replace it with the cherry picked provisions people like. It’ll all go with no guarantee that any provision will be preserved.”
“Oh, that wouldn’t happen,” then, she stopped; “You really think Donald Trump could win?”
“Yes, he could win.” Too bad that conversation happened last week before today’s insane Trump press conference. Oh, well.
Despite not being able to talk about Trump calling for Russia to release more DNC emails, I think I made her think that repealing the ACA isn’t as black and white as the news media portrays it to be.
Sometimes you can go positive and show how the law could improve their lives. Last week I was teaching a class on the ten essential benefits mandated in the ACA. Many knew that maternity coverage had to be included in their policies, but most didn’t know that birth control is considered preventive medicine and therefore, free under the ACA. This class is filled with Miami conservatives, but the idea that birth control is “free” perked them right up.
“But I have to pay $40 a month for my pills”
“I didn’t get the method I wanted because it required a $2,500 copay.”
“Those plans may be out of compliance with the ACA. There is supposed to be at least one free method for each of the 18 types of birth control per non-exempted qualified health plan. You should call you insurer and find out which ones are free and talk to your doctor about getting on a free method. If you find out you’ve been paying for one that’s supposed to be free, the you need to fight it and get refunds.” (I still can’t believe how many woman aren’t aware of this part of the ACA, but they were more than happy to learn.)
“Who do I call”
Then, I heard the real question.
What happens if they repeal Obamacare?
Then, we go back to the days where maternity coverage is a rider on a policy and you get to pay for your birth control.
There was generalized grumbling at that with an occasional “Shee it” or “Daa aaammmn” tossed in here and there.
“I get it. But, Well. ... You don’t have to like politics, a lot of people do hate politics. That’s all in well, but you do need to pay attention because the results affect your life.”
I was gratified to hear a “True, that” in the general hub bub.
The one issue no one has challenged me on is buying coverage across state lines, but that’s beatable too. Here’s where you get the skinny on that. The National Association of Insurance Commissioners, a board currently dominated by the GOP doesn’t think buying health insurance across state lines is a good idea. Their issues with this myth are:
• Allowing banks to choose their own regulator was a major cause of the current financial crisis.
• Insurers will seek the regulations that allow them to most aggressively select the healthiest risk.
• While those individuals in pristine health may be able to find cheaper policies, everyone else would face steep premium hikes if they can find coverage at all.
• Interstate sales would allow some insurers to cherry-pick the best customers by avoiding consumer protections that require them to cover individuals with preexisting conditions and limit their ability to charge higher prices for older, sicker customers.
• In states with robust consumer protections, insurers could reap huge profits by skirting these rules.
• Out-of-state insurers would be able to lure healthy enrollees away from existing risk pools, which would become progressively sicker and more expensive until they ultimately fail.
• Insurers that currently comply with state consumer protections would be forced by out-of-state competitors to evade them as well.
• Insurance policies would cover less and less, as insurers try to design polices that discourage the sickest customers from applying.
• Interstate policies would for the first time allow insurers unlicensed in the purchaser’s state to sell health insurance, which would otherwise be a criminal offense.
• Licensure is the key that allows state regulators to take action to protect consumers.
• The regulators of one state have no authority to enforce the laws of another state. Instead, consumers will have to hope that the regulator in a distant jurisdiction has the ability and resources to assist consumers nationwide.
The bottom line in defending the ACA is make it personal to anyone thinking of voting for anybody but HRC. We need to expand the ACA, not repeal it. I can only hope good sense prevails and we have a landslide for HRC in November.