… which could soon be no more.
I don't often get personal in my political writings, but my healthcare circumstance is a case study that will be replicated among millions more. You may read of my case as a kind of metaphor for the cold-blooded calamity that the GOP has in store.
I'm covered by Medicaid because my meager widower benefits and minimal income from writing qualify me as impoverished, although, since my wife died five years ago, I've been greatly enriched by Medicaid's assistance (I'm not of Medicare age), which picked up where her private, university-employer insurance left off. I'm also covered because I reside in a civilized state (Illinois), unlike my home state (Missouri), to which I'd like to return but can't; its Republican legislature has refused to expand Medicaid under the ACA. My most acute reason for wanting to return home is more than nostalgia. My mother is now in a nursing home there, and I'd like to be near her in her final years. But I can't be near her, for I'd lose my healthcare coverage (meaning essential medications for COPD, hypothyroidism, and now ulcerative colitis). The imposed distance — the separation of mother and son — has been an unspeakable heartbreaker.
According to this morning's NY Times story, "G.O.P. Plans Immediate Repeal of Health Law, Then a Delay," an already scrambled Medicaid system nationwide will be thrown even more egregiously into classic Republican disorder. Paul Ryan & Co. are planning "repeal and delay" rather than repeal and replace, which, notes the Times, "would be extremely damaging to a health care system already on edge." Quoting a healthcare expert: "The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy. Insurers need to know the rules of the road in order to develop plans and set premiums."
The Medicaid plan in which I'm currently enrolled is administered by a private provider, which is closing its Medicaid doors in 28 days. I have yet to receive state notice of any alternative plans for 2017. I repeat, I'm 28 days from no coverage. I don't blame the private insurers in hiding. What provider would want to engage such a discombobulated, unpredictable system, made even more incoherent by an ideologically indifferent congressional party?
The concept of "repeal and delay" strikes at the heart of the pending disarray. "[Republicans] hope to move forward in January or February with a budget blueprint using so-called reconciliation instructions, which would allow parts of the health care law to be dismembered with a simple majority vote," reports the Times, which adds the kicker: "They would follow up with legislation similar to a bill vetoed in January, which would have repealed the tax penalties for people who go without insurance and the penalties for larger employers who fail to offer coverage. That bill would also have eliminated federal insurance subsidies, ended federal spending for the expansion of Medicaid, and barred federal payments to Planned Parenthood clinics."
Will the enactment of this follow-up legislation also be delayed? On that, there is no clarification, probably because the Republicans intent on doing so much damage have yet to precisely determine how to do the greatest possible damage, which appears to be their greatest desire. For now, all we know with epistemological certainty is that the GOP's vague mess of a plan "is meant to give Mr. Trump’s supporters the repeal of the health law that he repeatedly promised at rallies." Many of these supporters are white working-class Medicaid recipients who possessed no idea of what they were voting for — of the damage they were doing to themselves.
As of Monday, I'm probably looking at hospitalization because of the life-threatening chronicity of ulcerative colitis. My privately provided Medicaid plan has so far denied coverage of several drugs (including a U.C.-unrelated narcotic that has effectively reduced a gut-wrenching cough: $52 out of pocket) that might have averted the far higher cost of the last-resort drug for U.C., now under medical consideration. And yet the stop-gap drug costs approximately $20,000 a year (which runs throughout the remainder of one's life; there is no nonsurgical cure for this condition). Will this drug be covered? I don't know. If not, there will be no need for Monday's hospitalization needed to administer the drug.
Ultimately, a total resection of my colon would be necessary. What, though, does "ultimately" mean? By then, will "repeal and delay" of the ACA have become "repealed and replaced"? — with no actual, credible coverage replacement for the millions of Medicaid's impoverished?
My complications are minor compared, say, to those on Medicaid racked by cancer — in need of chemotherapy, radiation and, often, surgery. What will become of those thousands, possibly hundred of thousands, once Republicans have completed their ideological program of Medicaid destruction? What will they have in two years or three? Health savings accounts, in which the impoverished can save nothing? Tax credits to buy some vastly inadequate, voucherized plan?
Would that I could say the personal cruelty and social indifference imbued in Republicans' healthcare "reforms" approach the unfathomable. But that is no longer the case, for cruel indifference to the needs of millions has come to define the very essence of modern Republicanism. And yet I don't really blame the ideological monsters now in total federal power. I blame instead the nearly 63 million, self-destructive, utterly uninformed imbeciles who put them there.