I should start by readily acknowledging the fact that I am not an expert in the policy or politics of the American healthcare system. But as a college student with a lifelong history of heart disease—I’ve got the pacemaker and everything—it’s a subject that I don’t take lightly, especially as I near the day when I’ll venture into the job pool and out of my eligibility for dependent coverage on my parents’ health insurance.
Under the Affordable Care Act, insurance carriers that provide for dependent coverage are required to continue doing so until said dependent reaches 26 years of age. A White House fact sheet on this particular aspect of the Affordable Care Act wastes no time in pointing out that because of the guarantee on extended dependent coverage, “Many parents and their children who worried about losing health insurance after they graduated from college no longer have to.”
I was aware of this worry from an exceptionally young age, conscious of the fact that my operations and check-ups weren’t paying for themselves. And of course, I worried how I would foot the bill once my parents were no longer around. My aspirations were framed by an awareness of the fact that financial stability pays for medications and new pacemakers—and that being a starving artist was out of the question.
The Affordable Care Act is a giant step forward towards the provision of healthcare for every American—not just those of us born healthy or with the means to pay for top-notch treatment. It’s a step propelled by expanded coverage for unemployed college grads, reforms that prohibit insurance companies from denying coverage to those with pre-existing conditions, and, in the individual and small group market, regulations that protect people from being charged higher rates based on gender or health status. These are a few parts of a law that levels the playing field on the American right to preservation of life—admittedly, Thomas Jefferson might disagree with my interpretation there, but that’s beside the point.
It’s not lost on me that the above paragraph is also a rundown of the Affordable Care Act’s greatest hits. To those fresh off following the campaign trail—however reluctantly—the characterization might even be jarring after a season of Obamacare bashing—President-elect Donald Trump called the law a “horror” on more than one occasion. And of course, the concerns—articulated more clearly by people who aren’t reality television stars—are very real.
Late last month, the Obama administration released prices for many of the health plans under the Affordable Care Act, revealing sizable increases for many segments of the country. According to the most recent federal estimates, the average mid-level plan will cost around 22 percent more in 2017 than it did in 2016. Though, it should also be noted that 80 percent of Obamacare customers receive subsidies to help with the price of premiums and will thus not feel the full burden of price increases—that is if they’re willing and able to switch to a less expensive plan in their market. The rub becomes clear when we consider that changing hospital or doctor to start anew isn’t easy for people with complex health needs—the sickest Americans end up the most burdened. And of course, there are the matters of decreased willingness among insurance companies to participate—Aetna and UnitedHealth Group both recently announced drastic plans to pull out of certain Affordable Care Act marketplaces, citing lost profits—and the detrimental lack of buy-in among young people.
These might’ve been a few of the hitches Trump was considering when he made those sweeping condemnations, but here’s the bottom line: Because of the Affordable Care Act, an estimated 20 million people have gained access to health insurance, through Medicaid expansion, the federal marketplace, state insurance exchanges and yes, expanded dependent coverage.
That net result isn’t a pyrrhic victory. It’s worth every bit of the dysfunction.
Recently, Trump’s been softening on parts of the Affordable Care Act. First, he told The Wall Street Journal he was reconsidering his long-touted (and yelled) stance on the law. Then in an interview for “60 Minutes” he voiced his intention to continue the Affordable Care Act’s guarantee of coverage for people with pre-existing conditions and extended dependent coverage, saying of the latter, it’s “very much something we’re going to try to keep.”
He still appears set on following his campaign trail mantra of “repeal and replace,” but what exactly would do the replacing is unclear. In that “60 Minutes” interview he only described his shadowy plan as “great health care for much less money.” The uncertainty is certainly worrying—then again Ben Carson’s going to help, so what could go wrong?
Meanwhile, Trump seems to have quickly warmed up to at least a few members of the Republican establishment—I’m looking at you, Reince Priebus—and if his healthcare plan starts looking like those floated by the likes of House Speaker Paul Ryan, we could be in some major trouble.
The plan released by Ryan in June—which would make a tax-credit available to those buying insurance plans in state-regulated markets—admittedly can’t be done justice in this limited space. But here’s a rundown of a couple potential issues. The plan would tear down strong coverage requirements, eliminating insurance companies’ incentive to offer plans appealing to people who are, or might become, sick; the sale of insurance across state lines would mean that the state with flimsiest regulations would set the national standard; and protections for people with preexisting conditions would only apply to those with continuing health care coverage.
I worry about the worst case scenario, in which people made hopeful by improved access to healthcare are forced to go uninsured, dependent on the local emergency room for medical treatment.
If the Trump administration can provide those benefits better, great. But enough with the vague hyperbole; tell me how. And, in the meantime, let’s hope for once that Trump creates something as “great” as he says it is.
Jake Parker is a Trinity sophomore. His column, "thinking too much, feeling too little," runs on alternate Wednesdays.
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