A few years ago, George Poston started feeling unwell. He was short of breath and he went to see his doctor, who discovered an irregular heartbeat. By the time he got to a cardiologist, one of his legs was swollen.
When the tests came back, Poston discovered that he had deep vein blood clots that were breaking off and circulating through his system, traveling to his lungs to create a pulmonary embolism that was causing the irregular heartbeat.
Doctors weren’t immediately sure what caused the problem.
“They did genetic tests, looked at my medical history, but nothing came up positive,” Poston said.
Eventually, the medical professionals decided that Poston’s career was at the heart of the matter. Poston was an executive chef at a chain restaurant. He stood on his feet for long shifts every work day, which they decided caused the blood clots.
With that, Poston’s four-decade career in the food service industry was over. He couldn’t stand for entire shifts anymore, and his condition required him to stay on a regular prescription of anti-coagulant medication to prevent future blood clots. That put a damper on all kinds of activities he once enjoyed.
“If you get a cut or worse body blow and internal injury, might not be any way to stop it,” Poston said.
Poston first went to the doctor in February 2016. He’d lost his job a month before, but he elected to continue his health insurance through the cobra0 program, which allows you to continue to buy in to the insurance coverage offered by your former employer. But it was expensive. Due to an accidental late payment, he lost his coverage. He wasn’t aware of the problem for two months, during which he continued to go to the doctor without insurance coverage.
In that time, he racked up $6,000 worth of medical bills.
Unable to work, Poston went to the city of Auburn to see if he could get help, and signed up for insurance through Apple Health, the Washington state health insurance program for people with low incomes.
“Now they cover me, doctor visits, medicines, primary care physicians, they cover all of that,” Poston said. “I didn’t have to pay for that.”
The Affordable Care Act (ACA), commonly referred to as “Obamacare,” helped people like Poston by expanding coverage, guaranteeing certain services and prohibiting discrimination based on pre-existing conditions. It did so by raising taxes on wealthy Americans, a move some have called one of the largest transfers of wealth in American history.
Now a minority of the Republican-held Senate, a majority of the Republican-held House of Representatives and a Republican president want to take that away. If it passes, no one, not even those with employer-based health care, will go untouched.
Rhetoric from the right, particularly President Donald Trump, that the change will result in better health care is ludicrous, Poston said.
“He’s talking out of his you know where,” Poston said. “That has no basis in reality. What they’re trying to do is trying to convince people so they can pass this thing and get tax breaks. Eventually we’re going to come out with nothing. It’s a problem.”
Poston’s words turned out to be prophetic.
The Better Care Reconciliation Act (BCRA) is the Senate’s take on the American Health Care Act (AHCA) that passed the House of Representatives on May 4. It’s so fundamentally unpopular that Sen. Mitch McConnell, the majority leader in the Senate, couldn’t muster the votes to pass it along party lines, even using the reconciliation tool allowing the Senate to usher it through with only 50 votes.
The bill would deprive 22 million Americans of health insurance, compared to current law, within a decade. Insurance companies could charge elderly folks up to five times more than a younger, healthier person. People with pre-existing conditions could not be denied coverage, but they might not be able to afford a plan that actually covers necessary services. Lifetime limits on coverage would once again be allowed. States, no longer offered the open-ended funding from the federal government to pay for insurance for low-income and disabled people, would have to find ways to come up with the money or ration care.
And, because many worker protections would be removed, the Congressional Budget Office estimates that 4 million people who currently get their insurance through the workplace would either lose it or choose not to pay for it.
The result: Tens of millions without necessary health care to cut taxes for America’s richest individuals.
Hasan Blount, a pedicab operator working on the Seattle waterfront, knows what he thinks about the bill.
“This bill is terrible,” Blount said. “It’s for the rich to fuck over the rest.”
Blount is self-employed and gets his insurance through Apple Health, the Washington state version of Medicaid. That program, originally available only to disabled people, children, parents and pregnant women, expanded under the ACA to include all people at or under 133 percent of the federal poverty level.
Thirty-one states took advantage of the Medicaid expansion, in which the federal government covered the vast majority of the additional cost with the intent to slowly wean support from the states. Even with the planned reduction in the rate of federal spending, the commitment to support Medicaid remained open-ended, meaning that per-patient costs were never capped.
The Republican bill would change that. The BCRA cuts $772 million from Medicaid over the course of 10 years by offering states either a block grant — a fixed sum of money over which they have more flexibility on spending priorities — or per-patient spending caps that grow more slowly than the rate of inflation on medical procedures.
It’s a Janus-faced move that transfers power over people’s lives to state governments without the money to make it work.
“That’s the way things work now,” Blount said.
The bill, as proposed, perverts the Republican refrain of “states’ rights” by offering flexibility for states to craft health care requirements while denying necessary resources to implement them. It allows some ACA provisions to stand, such as certain coverage requirements, but it allows states to apply for waivers, effectively opting out of certain responsibilities they currently have.
One of those is “essential health benefits,” a wonky phrase that promises that every health plan on the market, no matter who provides it, will cover certain services including mental health care, substance abuse disorders and childbirth.
Half of all Americans live in a state that likely will apply for these waivers, according to the Congressional Budget Office report on the bill. That represents a tectonic shift in the provision of health care in the United States, and could serve to undermine the overall quality of health care available.
Back in the day, less than 10 years ago, people could buy plans referred to as “mini-meds.” They had low premiums (the “subscription costs” paid whether or not coverage is used) but high deductibles (the amount that you pay out-of-pocket before insurance kicks in) and they didn’t cover much.
The ACA prohibited those, mandating that all insurance cover at minimum a set of health conditions at a variety of rates. Bronze plans meant that patients paid out 40 percent of the cost of health care, while silver plans, more expensive on a month-to-month basis, covered 70 percent.
That mandate and the expansion of Medicaid to low-income folks revolutionized health care in the United States, opening the door to poor people who needed help with a substance abuse disorder or mental health problems that they could never afford to treat before.
Taking away those prohibitions means that people could buy insurance that hardly helps them and employers could offer similar programs.
This is likely to hurt low-income people the most because decent health care is a must for business owners trying to attract employees in high-demand professions.
Steve Evos owns and operates Attack Pattern, a software development firm based in Seattle. Attack Pattern, named after a Star Wars reference, needs top-tier software developers in a region where talent could easily go to an Amazon or Microsoft. That means skimping on health insurance is a no-go, Evos said.
The bill has created so much uncertainty that even Evos, who’s plugged in to news coverage of the law, doesn’t know what it will mean for him.
“I’m curious from a business perspective for me and my team,” he said.
For every Evos trying to figure out how this bill will impact them, there’s a Shelby Allen.
Allen, self-employed, is a young man who purchases insurance through the Washington health care exchange. He’s not paying a lot of attention to the Senate or House bills, which would — according to the CBO — likely make his insurance more expensive and less generous in coverage.
The “majority of his body” doesn’t care, Allen said. The “smart part” realizes that getting rid of health insurance or making it more expensive could impact him, as well as the other 22 million people who would no longer be covered in 2026.
It’s not that Allen doesn’t know the value of health care; he broke his back when he jumped off a roof fleeing the mother of his child who was chasing him with pepper spray. He was under 26, and still on his parents’ health insurance at the time.
“I just jumped off without looking,” Allen said, making a ‘whoosh’ sound and mocking a superhero pose. “And we were butt naked!”
Many people seem to share this collective amnesia around health insurance, and what the picture was like before the passage of the ACA. It’s only been seven years since the law passed, but trying to get people to describe how health care operated before is a difficult task.
David L. Thompson, the vice president of public policy at the National Center for Nonprofits, said that back when phones were plugged into the wall, young people just didn’t pay for health insurance.
“Interestingly it wasn’t as big a deal,” Thompson said. “I liken it to the days when people drank and drove. It’s not something that you thought about until there’s a crisis. Young people are bulletproof, they thought they would live forever.”
Awareness about the importance of health insurance kicked off in 1992, when then-First Lady Hillary Clinton tried, unsuccessfully, to push through market-based reform. Before that, it wasn’t cool to talk about health care, Thompson said.
“It was not a good pick-up line in a bar in 1988 to say ‘I’m a health policy expert,’” Thompson said. “Then health policy nerds found love and had kids that were covered by the Affordable Care Act.”
The potential rollback of health benefits could hurt members of the Center for Nonprofits on multiple fronts, Thompson said. First is the ability to provide health insurance to employees — the center lobbied hard to make sure that certain tax credits that make it cheaper for small businesses to provide health care included the nonprofit sector, and is concerned about the upward pressure on costs for decent health care plans.
Second is that, pre-ACA, the nonprofit sector served those left out by mainstream, expensive health care providers without the benefit of offsetting revenue.
That’s the story of Neighborcare, a Seattle-based chain of clinics that offers sliding-scale rates to people without health insurance or who otherwise can’t afford care. The ACA relieved financial pressure on Neighborcare by offering coverage to its clients, allowing the group to expand services from 53,000 a year in 2013 (the year of the Medicaid expansion) to 68,000 in 2016, said Joseph Sparacio, chief development officer at Neighborcare.
It’s hard to say what will happen if the Senate bill, or something like it, passes because it’s impossible to determine what the state of Washington would do, given its commitment to health care, but also its dire fiscal straits, Sparacio said.
However, it’s possible that some of those significant gains for clients in the past three years could be rolled back.
“We have been serving the Seattle community since 1968. We were serving the community before there was an Affordable Care Act. We will continue to serve the community even if there is no Affordable Care Act, or if the provisions of the law were changed,” Sparacio said. “In truth, and I can’t sugarcoat it, it will be hard.”
Ashley Archibald is a Staff Reporter covering local government, policy and equity. Have a story idea? She can be can reached at ashleya (at) realchangenews (dot) org. Twitter @AshleyA_RC
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