How Republicans Boofed the Affordable Care Act
The Affordable Care Act, otherwise known as ACA or Obamacare, was designed to work in a particular way. It’s no surprise, then, that when Republicans refused to follow directions on it, chaos and suffering ensued.
01. What Is The ACA?
It goes by many names:
- The Affordable Care Act
- The ACA
- Obamacare
- The Patient Protection and Affordable Care Act (formerly)
It was the attempt made by the Obama administration and the 111th Congress to retool the way healthcare is done in the United States. For folks lucky enough not to know, getting medical care here is a bit of a minefield and has been for a long time.
Prior to ACA’s implementation, however, it was worse. Insurance companies could and would deny coverage to people with preexisting conditions. That was the big one, and the Obama administration did succeed in making that practice illegal. Obama the candidate made the mistake of telling people they could keep their doctor, full-stop, and that turned out to be impossible under the circumstances. The implementation of Healthcare.gov in 2014 was also pretty screwball, though it’s hard to say whose fault that was.
02. How It Was Supposed To Work
There are a lot of moving parts, but I’m going to focus on one: Medicaid expansion.
Now, Medicare and Medicaid are two different things, handled in different ways and at different levels of the government. The federal government is responsible for handling Medicare, which is primarily for people over 65 and those on disability. I have it because I was adjudicated disabled, after three years of waiting, in 2017.
Medicaid is handled by the states. Eligibility requirements, therefore, are decided by the states. The way ACA was supposed to work for low-income folks was by expanding Medicaid, and federal funding was offered to each state. Can anyone guess what happened?
What do you think the orange states have in common? Florida: Republican governor. Georgia: Republican governor. Wyoming: Republican governor. Tennessee, Alabama, Mississippi, Texas, Kansas, South Dakota, Wisconsin, North and South Carolina: Republican governor.
Republicans literally campaigned on the phrase, “I don’t want anything Obama wants.” This led to them fighting for the right to refuse to accept the federal funding and the right to refuse to expand Medicaid.
03. What Have Been The Consequences?
There’s this thing called the “coverage gap.” Healthcare.org has a very well-sourced article on the subject, and here’s their explanation:
In Washington, D.C. and the 36 states where Medicaid eligibility has been expanded, adults up to the age of 64 (who meet the immigration status requirements) are eligible for Medicaid with a household income up to 138 percent of FPL are eligible for Medicaid.
But in the states that have not expanded Medicaid, eligibility is still based on pre-ACA guidelines. In most cases, that means Medicaid is only available to people with disabilities, low-income children and pregnant women, and extremely low-income parents. In Alabama, for example, Medicaid is available for parents with a household income of up to 18 percent of FPL (13 percent plus the 5 percent income disregard). For a family of three, that’s $3,909 in annual income in 2020. If the family’s income exceeds that amount, the parents would not qualify for Medicaid.
And Medicaid is generally not available at all to childless adults in states not expanding Medicaid, regardless of how low their income is.
I mentioned, above, that I’m disabled. I applied for disability benefits in 2014, when I began to realize that my health problems were not going to allow me to earn a consistent income. My application was eventually approved, in 2017, almost exactly three years later. You get the sense, in this waiting period, that they’d rather you just die in the queue.
The ironic thing is, if I’d had access to any kind of healthcare in the preceding years, I might not be on disability today. With the approval came access to Medicaid, which I would have had access to if then-governor Rick Scott had chosen to expand Medicaid in the state of Florida.
Let me be clear: I had virtually no income. I had food stamps about half the time, because Rick Scott had also made the choice to make it harder to get food stamps. Anybody considered able to work had to be working in order to receive food stamp benefits for longer than a few months. (He also tried to mandate drug testing of welfare recipients, which was a transparent cash-grab that revealed lower drug use rates among welfare recipients compared to the rest of the population.)
So, I’d have food stamps for a while, then they’d get cut off, and I’d have to wait and reapply when my eligibility kicked back in. When I didn’t have food stamps, my food came primarily from food pantries and whatever I could make by selling plasma.
It created a perfect storm for me, and for many others. Not only was I denied access to medical care, but I was also unable to afford quality, nutritious food. At the same time, I was selling blood plasma twice a week, most weeks, thereby making my body work harder at a time when it was at its most vulnerable.
(There’s no love lost between me and Rick Scott. But everything I say is true, and you can verify it for yourself. That’s the thing: you can’t make this stuff up.)
04. What If ACA Is Overturned?
It’s hard to know, truthfully, exactly what the consequences would be, how bad they would be, and for whom.
The Supreme Court ruled that state autonomy meant the states could refuse to expand Medicaid. In the states that already have done so, it’s hard to imagine they’d go to the trouble of undoing it. But it’s also hard to see why they’d continue to vie for ACA being overturned during a raging pandemic.
That just seems mean.
On the other hand, some folks seem to have a foundational lack of understanding when it comes to the government and insurance. More than once, I’ve seen photos of people holding signs with slogans like, “Get your government hands off my Medicare.” And they’ve done man-on-the-street experiments asking folks whether they like Obamacare, followed by asking their opinion of the Affordable Care Act. Many of them did not understand that Obamacare and ACA are synonymous.
Wrap-Up
The Obama administration was by no means perfect. I’ll be the first to admit as much. And I’ve said, many times, that if Trump had pleasantly surprised me as a president, if I had been wrong about him being a corrupt narcissistic sociopath, I would have been the first to admit I was wrong about that.
Hell, I voted for Biden, but he’s way too moderate for my personal inclinations. Even so, I genuinely think that he will at least try to do what he thinks is the right thing to do. At the very least, I don’t think he’s the sort of person who is intentionally malicious. A gaff machine, sometimes, sure. And he voted, years ago, to make it impossible to get rid of student debt by way of declaring bankruptcy, which I don’t love, either. But at least he won’t be hobnobbing with dictators and calling white supremacists “very fine people.”
If we can start there, maybe we’ll be okay.
