| by Victoria A Brownworth

GOP Congress Votes Against American Lives

Health,
Women, LGBT, working poor biggest losers in Obamacare repeal.

Women, LGBT, working poor biggest losers in Obamacare repeal.

As the clock ticks out on the Obama Administration and every day brings America a new stunning reveal from the incoming Trump team, President Barack Obama’s signature healthcare legislation is on the chopping block. Donald Trump promised to repeal the Affordable Care Act (ACA), commonly known as Obamacare, on day one of his administration. The Republican-led Congress began the process immediately upon being sworn in. On January 11, the votes began in what was termed #votearama.

Sen. Mike Enzi (R-WY), chairman of the budget committee, said, “The Obamacare bridge is collapsing, and we’re sending in a rescue team. Then we’ll build new bridges to better health care, and finally, when these new bridges are finished, we’ll close the old bridge.”

And then what?

To their credit, every Democratic senator stood up for the ACA and even though no speech-making/debate is allowed in such roll calls, each made some comment, only to be talked over and told it was against policy.

But…America still lost. The ACA has insured more than 20 million people since it was signed into law in 2010, with the majority in the two years since most of the benefits became final. According to healthcare.gov, which manages ACA sign-ups, 11 million people have signed up in 2016 alone and the single highest enrollment day was December 15 when nearly 700,000 people signed up.

Lesbians of color, who are at higher risk of hypertension, kidney disease and breast cancer, will be impacted by repeal of ACA.

If Obamacare is unpopular with GOP lawmakers, it is definitely popular with average Americans. Ironically, a higher percentage of sign-ups were in red states than blue states.

Haunting ACA since its inception has been its cost. While plans for the majority of Americans became less expensive as government subsidies kicked in to lower premium costs, for many middle-class people rates went up. And for 2017, rates were expected to peak as some health insurance providers withdrew from the program, causing rates to soar. These premium costs were cited by a significant percentage of voters in November as a reason to vote against Hillary Clinton, a strong proponent of the ACA and health care reforms.

Those who have benefited the most under the ACA were women, who have traditionally been charged more for health insurance than men. LGBT people have benefited greatly from the ACA, as have working class and working poor families.

Now it is all on the line and without President Obama’s veto power, the repeal juggernaut is moving swiftly. In his Jan. 11 press conference, president-elect Trump insisted that there would be a “repeal and replace” process. But it was one he expected to have operational by the time his Health and Human Services nominee, Rep. Tom Price (R-GA) was confirmed. Price, who is also a physician, is a long-time critic of the ACA.

But while “repeal” has always been in the GOP’s lexicon, “replace” has not. There is currently no plan from the GOP to replace the ACA. Yet the repeal is moving forward.

For sick people, especially those with cancer or chronic illnesses, this is the worst news. One of the key provisions of the ACA, which finally kicked in January 2014, protected people with pre-existing conditions from losing their health insurance. For decades insurance companies had quietly expelled the chronically ill from their rolls. Hospitalizations, new diagnoses, even catastrophic injuries all led to either premiums that were too high to be affordable or simple cancelation of coverage.

Thus, that ACA proviso changed the lives of millions of Americans with diabetes, asthma, auto-immune diseases, cancer. Now those people – tens of millions – are back at risk.

Trump had said in a November 2016 interview with Lesley Stahl on 60 Minutes that he wanted to keep parts of Obamacare – notably protection for people with pre-existing conditions and coverage for kids and youths up to the age of 26. But even those were voted out in the Jan. 11 rollcall which came down to party lines: 51-48 (Dianne Feinstein was in the hospital getting a pacemaker and was not there for the vote.)

Also folded into the repeal was CHIP, Hillary Clinton’s signature healthcare initiative from 1993, when she was healthcare czar in Bill Clinton’s administration. CHIP (Children’s Health Insurance Program) has remained inviolate for more than 20 years and saved the lives of millions of kids.

Since it was signed into law in 2010, the ACA has been a source of contention within the GOP ranks and Republicans have voted 69 times to repeal the law since then. Each time the repeal vote has failed due to President Obama’s veto power. But with each successive vote, the animus toward the ACA has grown on the GOP side.

That animus was there from the beginning from GOP lawmakers who felt the ACA was a government intrusion into people’s personal health care choices. But with more than 40 million uninsured and under-insured Americans, it was essential.

The soaring costs of health care where uninsured people used emergency rooms as their personal physician because they had no insurance was creating a huge problem for anyone who was covered – the costs were being folded into premiums.

But the party that alleges it is for smaller government pushed for the law to be repealed as soon as it was law, taking their rage to their constituents with often false or misleading data. Former governor and vice-presidential nominee Sarah Palin made the ACA her signature issue, using her popularity among the most conservative Republicans to promote the idea that the ACA would have what she dubbed “death panels.”

While all insurance programs have always had caps on various treatment options and end-of-life care, Palin fixated on this as an element of ACA alone and pushed it on her website, Facebook page and in rallies against the ACA around the country.

Palin’s anti-ACA rabble-rousing put her on TIME magazine’s list of the 100 most influential people in the world in 2010.

In the 2010 midterm elections, Democrats lost the House largely based on the fight over ACA, and the GOP elected their new Speaker of the House, John Boehner, who was dedicated to the idea of repealing the ACA.

Now we are there. Palin was among the first to applaud the votes on her website headlining the move with “FINALLY! The Senate Delivers HAMMER to Obamacare Right At Midnight…”

The Republican Party, which has long termed itself the protector of family values, has never seemed more heartless. A December 2016 paper on the impact of ACA on coverage by the healthcare think tank, Kaiser Family Foundation, put the issue that will most impact women and LGBT people in the forefront: “Before private insurance market rules in the Affordable Care Act (ACA) took effect in 2014, health insurance sold in the individual market in most states was medically underwritten.

That means insurers evaluated the health status, health history, and other risk factors of applicants to determine whether and under what terms to issue coverage. To what extent people with pre-existing health conditions are protected is likely to be a central issue in the debate over repealing and replacing the ACA.”

The numbers are stunning. According to KFF, “27% of adult Americans under the age of 65 [the age at which Medicare coverage becomes available regardless of pre-existing conditions] have health conditions that would likely leave them uninsurable if they applied for individual market coverage under pre-ACA underwriting practices that existed in nearly all states.

“While a large share of this group has coverage through an employer or public coverage where they do not face medical underwriting, these estimates quantify how many people could be ineligible for individual market insurance under pre-ACA practices if they were to ever lose this coverage.

Lesbian families were able to protect their partners and their kids under ACA.

The KFF lists all 50 states and the number of people who will lose coverage due to pre-existing conditions. The numbers range from 94,000 in the least populous state, Wyoming, to over five million in California. The total: 52,240,000. And that does not include the millions who will lose coverage simply because they are covered through subsidies by ACA.

“This is a conservative estimate as these surveys do not include sufficient detail on several conditions that would have been declinable before the ACA (such as HIV/AIDS, or hepatitis C). Additionally, millions more have other conditions that could be either declinable by some insurers based on their pre-ACA underwriting guidelines or grounds for higher premiums, exclusions, or limitations under pre-ACA underwriting practices.”

Fifty-two million people means one in six Americans will lose health care coverage due to the ACA repeal.

The KFF also notes that well over half of all Americans has a family member with a pre-existing condition. What’s more, most insurers have expanded their list of what constitutes a pre-existing condition since the ACA. The range can run from the seemingly benign – allergies – to the more dramatic, cancers and auto-immune disorders.

For women and LGBT people especially, the loss of ACA provisions will be devastating. The ACA has made health care more affordable for women by forcing the marketplace to cease charging women more for health insurance. ACA has also forced maternity coverage, which previously was not an option in most plans.

Cancer rates for women are on the rise with lesbians especially at risk. ACA has prioritized preventative care. Younger women have often gone without health insurance because of affordability. Lack of health insurance has meant myriad illnesses, especially gynecological cancers, have gone undetected. Prophylaxis like the HPV vaccine which prevents cervical cancer is more available thanks to ACA.

The ACA protects LGBT patients from discriminatory practices based on their health status, such as being HIV positive or having Hep C. There are no limits on medical coverage based on health status, such as monthly or annual limits on HIV medication.

The ACA prohibits discrimination, so LGBT people are protected from discrimination by federal statute on the basis of sex stereotyping or gender identity, which means gender-non-conforming women and trans persons can feel safer to access medical services. Because homophobia and transphobia are such stressful factors in the lives of LGBT people, they are more prone to self-harm in all its forms, including addictions to tobacco, alcohol and drugs.

LGBT health disparities such as increased tobacco use and risk of obesity are addressed under the ACA through wellness and prevention treatments such as screenings, blood tests, counseling, and other services for no additional costs to the monthly premium.

Mental health coverage has been an acutely beneficial and much needed proviso of the ACA. Counseling, therapy, medications have all been more accessible due to the ACA.

Before the ACA women and LGBT people were marginalized by the health care industry. Accessing health care wasn’t just expensive, it was demeaning. Many lesbians and trans persons put off essential health care visits due to fears of discrimination.

Women’s health care necessities were previously out-of-pocket expenses–from birth control to cancer screenings like PAP tests and mammograms. Women of color especially have benefited from preventative screenings provided under the ACA as they are more prone to killer hypertension, kidney disease and aggressive breast cancer than white women.

The fight to have birth control covered impacts all people who menstruate, not just as a pregnancy preventative, but because birth control pills are also used to treat PMS, PMDD, endometriosis, migraines, acne and the onset of menopause. In trans men who have not had hysterectomies, birth control can be used to stop menstruation.

The expense of these drugs – used monthly for years – was oppressively out of range for many women, particularly younger and working class women. ACA changed that. No one can assess how many lives have been saved by early cancer screenings. Nor is there a way to gauge how many abortions have been prevented (since the GOP is concerned about this) by having ready access to viable birth control methods from IUDs to diaphragms to pills. But what is obvious is women were finally able to gain some measure of equality of coverage under the ACA which had previously been denied them.

Access has been the pivot upon which the ACA has evolved and grown over the past seven years. The need for universal health care persists, but ACA is the closest we have come to it. There is no more important issue for anyone in America – except having a place to live and food to eat–than access to health care when needed. That the GOP Congress and the incoming administration would take away the health insurance of at least the 20 million covered by the ACA and the eight million by CHIP is inconceivable. That they have no rationale for doing so nor any replacement at the ready is unconscionable.

With 52 million people with pre-existing conditions at risk along with the 28 million covered by ACA and CHIP, one thing we know for sure about the ACA repeal: People will die. Children will die, people with cancer and HIV will die and women, who are always the canaries in the coal mine of societies in peril will die.

There is still time to try and stop the repeal by flooding the Congress with your concerns. But the process is in motion and the clock is ticking. Contact your congresspersons tomorrow and every day thereafter. Tell them one thing: “If you repeal ACA, people will die. I don’t want to be one of them.”

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