A secretive Senate working group is closing in on a bill to overhaul the U.S. healthcare system by gutting Medicaid and the Affordable Care Act (ACA). With Republican leaders tight-lipped, the details of what’s in the bill remain a matter of speculation.
The closed-door deliberations by this all-male cabal of Republican senators are antidemocratic to the point of parody, but the stakes are dangerously high. Healthcare is not just one sixth of the U.S. economy: It is critical to people’s wellbeing and very survival.
These draconian policies would never pass through an accountable, participatory public process. By fast-tracking this bill with no transparency or public hearings, and perhaps as little as a handful of days for any public response, they are threatening tens of thousands of people’s lives.
How many lives could be at stake? If the Senate bill cuts 23 million people off of Medicaid and ACA insurance plans as the Congressional Budget Office calculated the House healthcare bill would, estimates suggest that somewhere between 17,000 and 44,000 people would die every year.
Skeptics may quibble that these estimates lean high, but does the precise figure matter? How many lives would it be acceptable for Republicans’ healthcare cuts to take?
Widespread suffering borne unevenly
Death by a thousand Republican cuts would hit people of every race and every gender in every state. Even people with comfortable incomes and comprehensive employer-sponsored insurance are just one illness, divorce or job loss away from danger. Yet the harm of the Senate bill would overwhelmingly fall on poor people, sick people, older people, women and people of color.
Senate Republicans’ plans would do incredible harm to poor and working-class people by slashing Medicaid and ACA subsidies in order to fund an enormous redistribution of resources up the income ladder. These funding cuts, along with deregulation of private insurance, would exacerbate the existing failures of the insurance market by raising people’s premiums and out-of-pocket costs, limiting coverage and leaving many uninsured entirely. All this would especially hurt the very people who most need care: people with serious illnesses and chronic conditions, as well as older people.
Women and people of color are disproportionately poor and thus more likely to be hurt by cuts to Medicaid and ACA subsidies. Women are impoverished by wage inequality, part-time jobs that don’t provide health benefits and lack of payment for domestic work. They would also be hurt by Republican plans to defund Planned Parenthood. Black and Brown communities are kept poor by racial inequities in public health, criminalization, education, hiring, housing, banking, and other arenas, and would thus be especially hard hit. At the same time, because more white people rely on Medicaid and ACA subsidies than people of any other racial or ethnic group, huge numbers of poor and working-class white people would be hard-hit too.
Illnesses and deaths ripple out too, taking an emotional and financial toll on entire families. The communities that Senate Republicans are targeting have the least resources to cope with the loss of a wage earner, caregiver or loved one.
Death by unnatural causes
Preventable deaths are not a natural disaster. They are produced by policy choices and are, by definition, totally avoidable.
The root of the problem is the way the U.S. healthcare system prices and pays for healthcare. Other wealthy countries guarantee healthcare to everyone as a fundamental human right by controlling healthcare prices and levying taxes to pay for healthcare as a public good. But in the U.S. healthcare system, insurance, hospital and drug corporations are allowed to set healthcare prices virtually without limit, and the private insurance system allocates healthcare not to those who need it, but to those who can afford to pay.
This pay-for-access healthcare market puts up cost barriers that force an enormous number of people to forego needed care. According to a survey by The Commonwealth Fund, even after the coverage gains of the Affordable Care Act, 63 million people (one in three adults under 65) skip doctors’ visits, prescriptions and other needed care because they can’t afford the costs. All these people suffer, and a portion die. The Senate bill would force this needless misery on millions more.
It’s not hard to see why costs create a barrier to care. In some cases, the ACA allows insurance companies to charge deductibles of over $14,000. Out-of-pocket costs that high prevent even middle-class people from going to the doctor and filling prescriptions. And if Senate Republicans have their way, deductibles could rise much higher.
For poor people, the cost barriers are even worse. Working a low-wage job and struggling to pay for rent, transportation, food, utilities and other necessities means that even a $20 copay can be prohibitively expensive.
Market-based healthcare pricing is especially cruel to poor people, but it hurts us all. People in the United States pay far more for healthcare than any other nation. We have the worst health performance in the industrialized world. And by dividing us into categories and forcing us into isolated struggles for survival rather than uniting us around our shared needs and values, the health insurance market frays our democracy.
Ultimately the only way to remove cost barriers and to stop forcing people to die tragically preventable deaths is by moving from private, for-profit insurance to a universal, publicly financed, single-payer insurance system. In the meantime, Senate Republicans must be stopped. Our lives depend on it.
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