The Terrible, Really Awful Senate Healthcare Bill

People will die.


AP/Wilfredo Lee Demonstrators protest during a health care demonstration outside the offices of Rep. Carlos Curbelo (R-FL), Thursday, May 4, 2017, in Miami.


It was a scene few could have imagined witnessing: Women in wheelchairs, some middle aged, some young, arms above their heads, their wrists handcuffed in zip ties, being led to a waiting police van.


On June 28 dozens of disability rights activists, many in the aforementioned wheelchairs, were arrested by Capitol police outside the offices of various U.S. senators. These mostly women and some men, joined by others who were not arrested, were protesting the Draconian Senate healthcare bill, ironically titled the Better Care Reconciliation Act (BCRA).


Outside the Capitol, hundreds of other protesters were chanting and waving signs. Many had placards with the photo of a loved one who would be impacted by the massive cuts to care embedded in the BCRA, which is a barely disguised tax cut for the wealthy on the backs of the sick, disabled and working poor.


Release of the Congressional Budget Office (CBO) report on BCRA was devastating. President Trump had insisted last month that the Senate bill would be "a beautiful thing," after declaring the House version–the American Health Care Act-- "mean." 


But if anything, the Senate’s version, drafted by 13 white male senators behind closed doors, was meaner.


And with no women on the committee, incalculably anti-woman.


In 2018 15 million Americans will lose their health care if the Senate bill were to become law. In total 22 million would lose their insurance with another four million losing their employer-provided health insurance. Employers are currently obligated to provide insurance as mandated under the Affordable Care Act (ACA) commonly known as Obamacare. That would end if BHCA is passed.


As I reported back in January when the process of gutting the ACA began, women would be most at risk as would anyone with a pre-existing condition. 


In the latest version of overturning Obamacare, the CBO report estimates as many as 49 million will lose some health insurance coverage and an unknown number that could be as high as 71 million will lose access to Medicaid. The numbers are dizzying. But a tax break for the one percent is factored in, so in Republican Party terms, it’s a net positive.



As McConnell and others have said, the government should not be in the business of providing health insurance. Vice President Mike Pence, who was responsible for what the Centers for Disease Control (CDC) termed a mini-epidemic of HIV as governor of Indiana when he closed Planned Parenthood, thinks "personal responsibility" is an issue with health insurance.



Pence and other GOP lawmakers have claimed people just don’t do enough to stay healthy so they don’t need Medicaid or comprehensive healthcare plans. Last month Rep. Mo Brooks said healthy people shouldn’t be penalized by having to pay for sick people–missing the entire point of what insurance does and how risk pools work. Of course healthy people pay for sick people. And then when they are sick, different healthy people will pay for them. Just llike safe drivers pay for people who have accidents and homeowners pay for insurance for other happenstance. No one plans to be chronically ill or suddenly disabled. But in a democratic society we don’t set those people adrift with no resources should those issues befall them.


The Senate GOP bill suggests maybe taking away the health insurance of the sickest and poorest Americans will somehow benefit America.


It won’t. First of all, who is sick?


In a nation where one in three people has heart disease, one in five people has a mental illness, 15 million people have cancer, 29 million people have asthma and 30 million people have diabetes, just to name the most common illnesses, nearly everyone is going to be sick at some point.


By mandating insurance and requiring insurance companies to cease certain practices like jettisoning people with pre-existing conditions and charging women nearly double for health care plans, the ACA broadened the risk pool which lowered the costs of health insurance for everyone. That meant more people–26 million more over the past seven years–could be insured.



There were glitches–some insurers didn’t like the law and opted out of covering people in various states. But those glitches could be fixed. If only the GOP had the will.


Some may. Not all Republicans were on board once the BCRA was revealed on June 23. Some, shockingly, found the bill didn’t go far enough in overturning the basic tenets of the Obamacare law that had mandated all Americans be covered or pay an opt-out penalty. Others found the cuts to Medicaid and insurance subsidies would adversely impact their constituents. Ten of the 52 Republican senators were not ready to vote for the BCRA, which Senate Majority Leader Mitch McConnell had hoped to shove through before the July 4 holiday recess.


And not one of the remaining 42 was willing to say publicly on any TV news program that they supported the bill.


All 46 Democrats and both Independents are opposed to the bill. Two Democratic senators, Dianne Feinstein and Kamala Harris, both of California, proposed their own bill, which McConnell refused to recognize.


It’s impossible to overstate the damage the BCRA would do nor the havoc it would wreak. For people with disabilities or chronic illnesses like diabetes, MS, lupus, sickle cell or HIV/AIDS, it’s as close to a death sentence as one comes without actually sticking a needle in the arms of those people. Mental health coverage–already lean and lax in America–would become non-existent as would care for people with autism.


And that opioid addiction pandemic we keep hearing about which is expected to kill 500,000 in the next decade?


Kiss your rehab goodbye.


People will die.


Unsurprisingly, media has demanded an accounting from Trump. None has been forthcoming. The president has held not one press conference about the healthcare bill and made no effort to promote it or explain it except to make those statements that it will be "beautiful," even though it is anything but. Some pundits have questioned whether Trump, a notorious non-reader, has even read the 147 page bill.



It’s not hard to discern what the worst parts of the BCRA are. Planned Parenthood would be defunded immediately for at least a year for no reason other than the name is a lightning rod for the right which still believes that live babies are killed in Planned Parenthood clinics. (They are not.)



Defunding Planned Parenthood will hurt low-income and young women the most. Planned Parenthood provides a range of health care to 2.5 million women and men every year at 600 affiliated clinics in all 50 states plus the District of Columbia. Among those receiving care are people seeking testing and/or treatment for STDs as well as basic health care, in addition to birth control and hormone treatments.


Planned Parenthood has long been a place where LGBTQ clients can feel safe in their identities without fear of discrimination. Without funding, Planned Parenthood will be forced to close clinics, likely in the most needy areas.


The BCRA will raise premiums astronomically. This will impact people over 45 the most, with lower income people–mostly women–being forced out of insurance coverage. The CBO estimated annual increases of between five and 20 times existing costs under the ACA. Subsidies will be less and rates will be higher. The worst age group will be people between 55 and 64. And because women’s pay scales tend to get lower over age 50, the rise in premium prices will impact women right at the age when they are most at risk for breast and gynecological cancers as well as heart disease.



Perhaps the worst aspect of the Senate bill is it would slash Medicaid, the public health insurance program for low-income children, pregnant women, parents of dependent children, seniors and people with disabilities.


Obamacare created an option for individual states to expand Medicaid eligibility to low-income adults. This provision has been a major benefit for low-income LGBT adults as well as people living with HIV. Lesbians and trans persons are especially susceptible to job discrimination, which makes maintaining health insurance through employment particularly difficult.


According to Sean Cahill, Director of Health Policy Research at The Fenway Institute of Fenway Health, "The rates of uninsurance among LGBT people and people living with HIV dropped dramatically after the Affordable Care Act’s Medicaid expansion was implemented. While this bill would delay the dismantling of the Medicaid expansion, we don’t see anything that would preserve those gains."



Which means LGBT people could actually die. Several years ago a former partner of mine died at only 49 from a metastatic gynecological cancer. A butch lesbian with no insurance from her job, she also had faced discrimination when accessing health care. A cancer that could have been treated if caught early ravaged her and took her life in less than a year.


She is far from the only lesbian who has faced these issues–the confluence of homophobia and lack of health insurance has conspired to create a veritable epidemic of cancer among lesbians.


My former partner died before the ACA and its accessibility to low-cost health care plans and subsidies. Medicaid expansion was created specifically for working poor people with preexisting conditions who have limited income but are not on disability or other insurance. People like she was and many in our community–especially the very young and elderly–need this access desperately.


The BCRA ends that Medicaid expansion entirely and also slashes funding to the Medicaid program, which covers more than 60 percent of nursing home residents and close to 70 percent of American children. The Senate bill would also allow states to opt out of the most vital of the ACA’s health insurance requirements, including rules for what constitutes a qualified health plan and what health benefits must be covered. The ACA currently requires coverage of essential health benefits, including HIV/STI screening and behavioral health care. It also requires women be treated equally and screenings for cancer, like PAP tests and mammograms be covered and that maternity benefits be provided.



LGBT people, lesbian mothers, people living with HIV, trans persons undergoing hormone treatment, elderly LGBT people who are least likely to have adult children or other relatives to provide for them if they are ill or disabled–the full range of the most vulnerable members of our community–will be put at risk by the BCRA.


There are ironies that are hard to comprehend. McConnell contracted polio as a toddler. He was helped by a variety of services that have become government-run in the years since. He was a primary beneficiary of the March of Dimes, which contributed to saving his young life.


Yet last week when the organization asked, along with other healthcare groups, to meet with McConnell, he refused.



The demonization of Obamacare is in the name: Republican disdain for the former president was legendary and shockingly blatant. But it has meant the GOP tried more than 60 times to overturn the ACA–only to have those efforts vetoed by Obama. Now, with nothing to stand between the GOP’s visceral hatred of the former president and overturning a law that has benefitted millions, including members of their own families, they are poised to do just that.


Healthcare is a right in most Western countries. Our neighbors to the north and south–Canada and Mexico–both have universal health care paid for by the government. In 1993, then-First Lady Hillary Clinton attempted to overhaul the American healthcare system and get universal healthcare on the table. Then as now, the GOP balked.


For 20 years, Rep. John Conyers (D-NY) has put forward his Medicare for All bill, HR676, most recently on January 24, 2017.


It has never even gotten into committee.


Sen. Bernie Sanders (I-VT) has talked about single payer health care since his 2016 presidential run. But that discussion has been on TV, not on the floor of the Senate. And on June 28, Sen. Elizabeth Warren (D-MA) told the Wall Street Journal that it was time to discuss single-payer. But she does not have a bill, either.



What happens next remains to be seen. The outcry from the constituents that Republicans claim want to end Obamacare has actually been, with some few cherry-picked exceptions by the Vice President, overwhelmingly against overturning the law that has saved so many lives, my own included. A June 28 NPR/Marist poll found only 17 percent of Americans favor overturning Obamacare.


That’s not many people. Meanwhile, cutting 22 million people from health insurance would be equivalent to taking away the health insurance of every person living in Kansas, Nebraska, South and North Dakota, Idaho, New Mexico, Wyoming, Montana, Alaska, Hawaii, Iowa, Maine, Vermont, New Hampshire, Rhode Island, Delaware and the District of Columbia.


In May, after the House narrowly passed the AHCA, Trump invited House GOP to the White House. They celebrated with beer, high-fives and music in the Rose Garden.


Celebrated cutting tens of millions of their fellow Americans from desperately needed health care.


That is where we are in 2017. With a president who says a "mean" bill is a beautiful thing and a Senate Majority Leader who is only alive because others reached out to help the needy family of a little boy who was desperately ill.


The next few weeks will be important ones in America. Constituents must demand their senators listen to their stories and act accordingly. If not, there is no question, people will die.



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