Readers know I’ve been deeply engaged in the healthcare debate, and highly critical of the efforts thus far to repeal and replace, demean and deface, disgust and disgrace, etc.

But I haven’t weighed in on up to the minute changes in part because they’re changing fast and because the journalists who follow this are doing a good job of tracking developments in the Senate.

In sum, Senate R’s have failed to pass any of the repeal and/or replace bills they’ve come up with so far. At this point, McConnell looks to be counting on getting to 50 votes with “skinny repeal,” which gets rid of the individual and employer mandates, along with a tax on medical devices.

At one level, this is high strategery. His play is to get to conference, i.e., once both chambers have passed bills, the R’s convene a committee that tries to agree on a plan that R majorities in both houses will support. There’s no requirement that what comes out of conference looks like what went in, and that means they’re most likely to go right back to the full, draconian repeal-and-replace cuts that would lead to tens of millions losing coverage.

Would Senate “moderates” who’ve blocked these bills thus far backtrack and vote for stuff they’ve heretofore opposed, like huge cuts to Medicaid or ending coverage of pre-existing conditions, maternal care, mental health, substance abuse treatment, etc.? They might, but it’s worth remembering that the debate on the conference bill is constrained, no amendments are allowed, and leadership will be in full arm-twisting mode.

By Emily Gee and Thomas Huelskoetter

Later today, the Senate is scheduled to hold its initial vote on repeal of the Affordable Care Act, although nobody, including the senators themselves, know which bill will be up for a final vote. Reportedly the options for consideration include a previously-unseen “skinny” version of ACA repeal that would only include a repeal of the coverage mandates and the medical device tax. But this skinny repeal bill, if passed, would still have negative effects on health insurance coverage. It would also discourage issuer participation in the individual market and increase the average marketplace premium by $1,238 next year.

The Congressional Budget Office (CBO) has estimated that repeal of the individual mandate would result in 15 million fewer Americans having health insurance a decade from now. By 2026, about 15 percent of the nonelderly population, or 43 million Americans, would be uninsured.

Mandate repeal would affect the individual market enrollment in two ways. First, in the absence of a mandate, some younger and healthier individuals may decide to forgo individual market coverage. This phenomenon, known as adverse selection, would cause the average cost among enrollees remaining in the individual market to rise. In turn, issuers would need to raise rates. The CBO projects that premiums in the individual market would increase by “roughly 20 percent relative to premiums under current law.” Second, because these higher premium levels would not be affordable to some enrollees, more people would be forced to drop their coverage and become uninsured.

President Donald Trump continues to change his position on health care, and recent comments he made to The New York Times reveal he might not understand how health insurance even works.

In an interview Wednesday with The Times, Trump signaled that, if he could, he would strip away protections for pre-existing conditions — but he also said he is generally of the view that people should have health care.

“Once you get something for pre-existing conditions, etc., etc. Once you get something, it’s awfully tough to take it away,” Trump told reporters from the Times. “As they get something, it gets tougher. Because politically, you can’t give it away. So pre-existing conditions are a tough deal.”

Times reporter Maggie Haberman then asked Trump if he was “generally of the view that people should have health care,” to which Trump responded, “Yes, yes.”

But wanting to strip people of protections for pre-existing conditions is completely contradictory to the belief that people should have health care. Without protections that keep insurers from discriminating against individuals with pre-existing conditions, those people can be charged significantly more for insurance, which could ultimately price people with the highest need for care out of the market.

Every other Saturday morning, I inject $2,269.61 worth of pharmaceuticals into my leg. If I don’t do so, my immune system will slowly eat holes in my small intestine. Eventually, it will start leaking digestive fluid into my abdominal cavity until I literally devour myself from the inside.

I’ve experienced an intestinal rupture before, and can assure you that the pain is unimaginable. Unless you’ve laid on a gurney screaming for morphine before, there’s nothing I can say to convey what it is like. I wouldn’t wish that pain on history’s worst tyrants. I wouldn’t wish it on Mitch McConnell.

I tell this story because the Senate is poised to vote on a bill that will plunge thousands of people similar to me into economic ruin. Many of us will not survive if Trumpcare becomes law. Unable to even afford opiates to ease the pain, some of us could die excruciating deaths.

 

See that? That’s almost $2,300 worth of medicine. Or two weeks of life for me. CREDIT: Photo courtesy of the author.

The drug that keeps me from this fate is called Humira, and it is one of capitalism’s great miracles. AbbVie, the company that makes Humira, sold $12.5 billion worth of the stuff in 2014, more than any other drug in on the market today. A box of two 40 mg Humira shots costs $4,539.21.