What's at Stake With Your Healthcare

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Writer Mary Ladd
Writer Mary Ladd
Mary has breast cancer.


The woman you see in the photo has a message. A very powerful message and it's at the bottom of this piece. Please take the time to read it and when you are finished, take the time to think through the rhetoric and let your legislators know your opinions.

It's important that we all understand what replacement of the healthcare plan is actually going to do rather than keep talking terms and concepts most know little about.

Terms like "access" and "affordable" are relative but are being used to push the concept that paying less will get you more all things being equal. Obviously it's not possible. Healthcare has a cost and managing the system that delivers the care can result in actual savings. If no controls are in place to regulate the costs of drugs and other things that create huge costs, nothing will lower the actual cost of providing coverage.

Lawmakers have two votes in the next several hours. Assuming all goes according to plan — the House will then vote on two bills that form the core of their Obamacare repeal plan. One is a technical bill that eliminates an opt-out for members of Congress and congressional staff from the changes about to be made to the healthcare system. The second is the bill itself. Yes, they have to vote to eliminate the opt-out they built into the system that was so good for everyone except them.

This vote for health care "reform" will happen without an official estimate of how the latest revisions would impact its cost and coverage. Representatives are avoiding an uncertain assessment now (Why would anyone vote for anything not knowing what the impact will be?!) but risking a backlash when that estimate comes out in a week or two.

The current Republican bill will get rid of the ACA (Obamacare) requirement that people have health coverage or face a tax penalty. It will also eliminate the mandate that employers with at least 50 employees provide health insurance to their workers. Does anyone really believe that those with low paying jobs that now receive healthcare coverage from their employer will now get paid more in order to buy their own coverage?

Under the current ACA guidelines, companies had to provide affordable insurance to staffers who work more than 30 hours a week. They face a penalty if they do not meet this criteria and their employee seeks subsidies on the exchanges.

The Republican plan seeks to allow insurers to impose a 30% surcharge on the premiums of those who let their coverage lapse for at least 63 days. (Is 63 days a reasonable or prudent number? What calculation was done to arrive at 63 days? It is not an arbitrary figure. That number is there for a reason.) The plan would enable insurers to levy this surcharge for one year, but it would only apply to policies bought in the individual or small group markets. Once again, large businesses get a pass while individuals and small business can have insurers charge them more for less coverage than the current ACA provisions mandate.

Under a recent amendment to the replacement program, states that seek waivers could replace this provision with one that allows insurers to charge consumers who've had a gap in coverage based on their health status. The plan would enable insurers to levy this surcharge for one year, but it would only apply to policies bought in the individual or small group markets. Under a recent amendment, states seeking waivers could replace this provision with one that allows insurers to charge consumers who've had a gap in coverage based on their health status.

So, if your policy lapses for some reason, you are subject to even higher premiums. Know anyone that has lost a job or income due to illness? They can't afford to keep their insurance and when they get better they can't afford new rates as their premiums have been raised. Hospitals still have to treat them and we all pay the bill because they cannot. They likely have ongoing medical issues because they only get last ditch treatment and services with no routine care. Which cost us all less? Showing up at a hospital ER with a serious issue or having services when needed covered by affordable insurance that manages the delivery systems?

The proposed law will allow states to obtain waivers that would allow carriers to set premiums based on enrollees' medical backgrounds under several circumstances. Enrollees would have to have let their coverage lapse, and the state would have to set up a risk program (the high-risk pool) that, in some cases, could provide help to those being charged higher premiums. High risk pool insurance in Illinois was very expensive compared to other coverage when full underwriting was done to obtain health insurance in the past. There is no reason to believe that it would be different this time and it's reasonably certain that no form of subsidy will exist. Nothing other than being able to obtain Medicaid coverage that the state already struggles with will get a person with medical issues coverage.

States could also seek waivers that would allow insurers to sell plans that don't include all the essential health benefits mandated by the Affordable Care Act. Under ACA, carriers must provide outpatient care, emergency services, hospitalization, maternity, mental health and substance abuse, prescription drugs, rehabilitation services, lab work, preventative care and pediatric services. These services have been documented as best practices and are known to lower the ultimate cost of providing healthcare to a population.

Eliminating these two provisions could lower premiums somewhat and give consumers a wider choice of plans. But it would also make it harder for people to buy comprehensive coverage and weaken the protections for those with pre-existing conditions.

The proposed plan will also send the states a fixed amount of money per Medicaid enrollee, known as a per-capita cap. States could also opt to receive federal Medicaid funding as a block grant for the adults and children in their program. Under a block grant, states would get a fixed amount of federal funding each year, regardless of how many participants are in the program. Either option limits federal responsibility, shifting that burden to the states. However, since states don't have the money to make up the difference (Illinois in particular), they would likely either reduce eligibility, curtail benefits or cut provider payments. The block grant would be more restrictive since the funding level would not adjust for increases in enrollment, which often happens in bad economic times. The legislation would also end the enhanced match rate for Medicaid expansion for new enrollees starting in 2020. Those already in the program could stay as long as they remain continuously insured. States that have not already expanded would not be allowed to do so, starting immediately.

Under the current ACA, insurers can only charge older enrollees three times more than younger policy holders. The replacement bill will widen that band to five-to-one, which would hike premiums for those in their 50s and early 60s, but reduce them for younger folks. States would also be allowed to seek waivers to allow insurers to charge older consumers even more than five times younger ones.

The proposed legislation will eliminate the taxes the Affordable Care Act levied on wealthy Americans, insurers, prescription drug makers and device manufacturers. It It removes the ACA’s limit on corporate tax deductions for executive pay and will actually encourage health insurance companies to pay their top executives more!

Congressman Mo Brooks, Do You Want Me to Die?  By Mary Ladd

Representative Mo Brooks of Alabama, you’re essentially voting me off the island and dumping me into a bay of Great White sharks, where I will suffer and die in a sad and bloody fashion. Without medicine and treatment for a pre-existing condition called breast cancer, which I was “surprise!” diagnosed with at age thirty-nine, that’s what you’re doing. I won’t be alone as I gasp for air, since so many other folks with common health problems will be isolated, ignored and left out: from heart issues, to allergies, asthma, diabetes, other forms of cancer, as well as birth defects and strokes, we will not be able to pay our way to survival in America under your watch. When you allow these “pre-existing conditions” to be penalized, you’re making it become far too expensive for this lady.

I’ve had seven surgeries, 22 rounds of chemo, 8 infections and 69 blood draws. I wish my time in clinics, hospitals, and pharmacies did not have to be a part of my life, but realize there are so many fellow patients. We come in many shapes, ages, sizes, and personalities and may share the same goal: to feel better.
By repealing the affordable healthcare act (ACA) and bringing in a medical system that you think favors “good” people over an often sick 43-year old like me, your vote essentially dictates how long I will live, and how I will live. Even if I will live.

Since you have the vote, power and TV time, I am listening to you. But I don’t like what you’re saying and doing, and am offering a perspective that may persuade you to consider other ideas. As well as people that do not look or talk like you, but deserve help and care just the same.

When you said on CNN yesterday that people who lead good lives don’t have to worry about getting and dealing with pre-existing conditions, you’re basically telling the world — and patients like me — that I got cancer because I must be bad. Who are you to judge what is good or bad? There is no morality pledge to being American. I’ve eaten some juicy and rare beef cheeseburgers and kissed a lot of folks, but I continually work on myself to try and act as kind and friendly as I can to every being I encounter. If you want to paint folks as bad versus good, I’m not sure what other insights and data I can offer to affirm that I deserve to be able to stay in the city and state I was born in without plotting for a too-grim economic and health future that could happen tomorrow, next week or soon.

Your actions and words are a message that my life is not good and has not been good or worthy of help and consideration. It feels like you are putting the fault on me for getting a breast cancer diagnosis that happened to be the same day as “back to school night” for my young son. Tying my illness and pre-existing condition to a notion of goodness is frankly not fair and should not be a legitimate guiding principle for your vote.

A local breast cancer support group I am in welcomes an average of 30 new members a month. Are we all “bad” people destined for ginormous medical bills? Or no care at all? Do you genuinely think we have each done so many bad things that would cause us to have varying stages of a cancer that attacks our bodies and weakens us? Cancer causes us to cry and worry in the middle of the night over bills, symptoms. Along with the people we love, as we wonder, how many days/weeks/months/years do I have left?
How will I pay for it all?

Should we all really listen to the idea of having us move to whatever state will make it reasonable for us to live, work, and seek treatment in? Please mansplain where this state is, because I have many pals who require constant and quality medical help for access and information on the pills they take, and things like chemo, hormone therapy, hot flashes, horrible reactions (better left imagined than described), and itchy skin. Then there’s the awkward and embarrassing waffling between constipation and diarrhea in the same hour — a reality that is a visual and physical reminder of how precarious and crappy one’s health is. Combined with the anxiety and exhaustion that comes from knowing you may need to undergo chemo and other costly treatments and surgeries — all to attempt to kill the disease that is growing and attacking your body.

At 43, I’d like to think and hope that I will be able to watch my son graduate from high school. That would be a day that reflects hope, opportunity and hard work, and one that my own family celebrated with me when I graduated at age 17.

Other milestones tempt me daily to keep going. My mom just passed away on April 1 from complications related to a series of strokes. You would classify her as another one of your “she must not be a good person” pre-existing condition cases. I can’t imagine how (if?) her care would have been managed under your desired system — she could not move or walk on her own for over 15 months. So getting her to “move to another state” for us pre-existing condition folks frankly would have been impossible.

I have clogged eye ducts — from 22 rounds of chemo, it often makes it tough for me to type and look at my computer. This being modern times, I work hard at being able to show up for work, loves (family), friends and community. My eyes atrophied from chemo, so I have dried up eye ducts that are similar to those of an 83-year old, according to one of the many doctors I see on a regular basis. That means I often have to apply a steroid cream (medicine) to my eye lids and take a lot of time to wash my eye lids daily. That and using warm compresses helps my eyes feel closer to normal, although I do always need to have artificial tears nearby. This has all become routine, and involves me regularly going to a doctor and nearby pharmacy, where I sometimes sit on the ground because I am too tired and would not ask a senior or fellow ill person for their chair. A texting teen may get a meaningful gaze from me if I am especially zonked.

I have brittle bones from going through early menopause. My hysterectomy was tied to a tough decision related to my breast cancer and learning through medical treatment that I carry the BRCA1 gene — another unwanted (medical) surprise. There are many hours where I can barely stretch or move, because my joints are weak and stiff. That’s something I did not experience before I got that call from a lady doctor when I was 39. It seems to me that I am a good enough person, but instead got dealt a tough or less than ideal break genetically and medically speaking.

Again, why should my innate goodness matter?

Environmental factors are also at play when it comes to the causes of breast cancer, but my words here are meant to keep the focus on who deserves health care and why.
I have volunteered to help others since I could walk as a toddler, although my younger brother would probably have called it “bossiness” over “help” in our early years. I am friendly and enthusiastic often. When I see someone that needs a hand — from getting donations for a fundraiser for science labs at my son’s school to carrying groceries or offering an ear or advice to a fellow patient or writer who may be younger or older than me, I give it. I will carry someone’s books or bags if they look like they are in worse shape than me — even though I do tend to get winded or worn out often.

Senator, you have the power to make life healthy and good for many of us Americans. I will be watching through my sometimes-cloudy eyes to see what you say and do next, and hope you talk to your constituents, sisters and friends who may in fact be dealing with pre-existing conditions, extreme worry, serious illness and disease.

Mary Ladd’s writing has appeared in Playboy, Time Magazine, KQED, & San Francisco Weekly.


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