By Robert Stone, M.D.
The Journal Gazette (Fort Wayne, Ind.), Dec. 26, 2016
There is the story of the dog that chases a bus down his street day after day, barking furiously. One day the bus stops. The dog catches it. Now what?
The Republicans have been barking furiously chasing Obamacare (the ACA) and now are about to catch it. They have promised to repeal it on Inauguration Day. You may not recall that the original idea for the ACA came from the conservative Heritage Foundation and first became law as Romneycare in Massachusetts. President Barack Obama chose this Republican-created idea as a compromise, hoping to find some Republican support, but met uncompromising resistance.
Here in Indiana, almost 600,000 Hoosiers have health insurance through the ACA, more than 390,000 in HIP 2.0 and more than 196,000 through the exchange. Nationally, there are 22 million at risk of losing ACA coverage. There is no historical precedent for taking something this vital from so many Americans. That many losing access to health care would be a catastrophe and would translate into 22,000 preventable deaths a year.
We can’t tell what is actually going to happen. We know they have promised to repeal it and replace it, but the ideas floated about replacement are vague, and although much of the ACA could be effectively repealed in January, replacement would take longer. They say they want to keep the pre-existing condition protection, the part of the ACA that says that you can’t be denied insurance just because you have some sort of illness. However, if you take away the mandate to purchase insurance, which has been unpopular, it becomes impossible for insurance companies to sell insurance at an affordable price. The ACA was complicated for a reason. They never considered the elegantly simple alternative of expanding our existing Medicare to cover everyone.
The ACA was deeply unpopular from two directions – those who saw it as government overreach, and those who felt it didn’t go far enough by leaving 28 million uncovered and keeping the corporate interests (the insurance industry and drug companies) in control of the system. Now this originally Republican idea is going to be owned by the party that birthed it.
They will probably try to re-brand it the same way Gov. Mike Pence expanded Medicaid in Indiana under the ACA while insisting he wasn’t expanding Medicaid. He called it HIP 2.0, the Healthy Indiana Plan. Paul Ryan, the speaker of the House, has suggested they replace “premium subsidies” in the ACA with “tax credits.” No matter what we get, it will likely cover fewer people and include more “skin in the game” (a term I find offensive) – higher deductibles and out-of-pocket expenses. It will not bring down insurance premiums or make health care more affordable.
We have work to do at the state and national level to protect the 22 million at risk of losing their Obamacare. Indiana’s legislature, new governor and congressional delegation must work to guarantee that 586,000 Hoosiers are protected. We all know someone who could be given the boot.
Dr. Robert Stone is director of Hoosiers for a Commonsense Health Plan and state coordinator and national board adviser for Physicians for a National Health Program. He is medical director for the Palliative Care Program, Indiana University Health Bloomington, and assistant clinical professor, Indiana University School of Medicine.