About Health Care: I Am Not a Communist, I Just Care About People

There is solid logical and factual basis for opposition to the “repeal and replace” legislation passed by the House and now before the Senate.

Logic first.

Barring accident, taking preventative measures leads to better health and reduces the risk of future catastrophic illness.  Such measures include annual checkups, better diet, exercise and seeing the doctor when symptoms first appear.

Putting off prevention can lead to escalating problems and higher costs, like putting off repairing a few shingles in your leaky roof until the whole roof collapses. The logical result is wider damage and higher costs.

Most people, including me, tend to wait because of cost.

In my case, I could have avoided years of discomfort and permanent damage if I had not had a high deductible plan and put off seeing the doctor.  Rather than spend the money, I lived with the symptoms, with the self-deception that they might go away.

Logically, these tendencies are especially acute among poor working families, who tend to serve more immediate needs — like food and shelter — instead of spending time and money seeking medical advice.

If you cannot identify with this, you must be really lucky.  You should consider volunteering at a homeless shelter.

Now the math.

The data referred to in my last post simply confirms the above logic and puts numbers to the effects of health insurance contraction under the American Health Care Act (AHCA or “Trumpcare”).

If you want to dig into the numbers, look at the data from Idaho that describe the 78,000 uninsured who do not qualify for coverage — because they make too much to fit the narrow qualifications in Idaho for Medicaid and not enough to qualify to participate on the “Your Health Idaho” individual insurance exchange.  This is the estimated number of Idahoans in the “Idaho Coverage Gap”.

Then plow through the reports from the Congressional Budget Office (CBO), which “scored” both versions of the the American Health Care Act (AHCA), H.R. 1628 passed by the House of Representatives and  the Senate version of the bill ironically named the Better Care Reconciliation Act of 2017 (BHRA).

CBO has quantified what is obvious in the legislation: the Senate bill would eliminate coverage for 15 million Americans next year and for 22 million by 2026; cut Medicaid by $772 billion over the same period; next year increase individual market premiums by 20 percent; and, make comprehensive coverage “extremely expensive” in individual markets.

To try to understand the potential impact of the AHCA on poor Idaho working families spend time with analysis published by the Kaiser Family Foundation and at least one of several studies of the impact of coverage expansion (including Medicaid expansion) on general health and mortality rates.

map

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According to the KFF analysis, an estimated 4.5 million uninsured adults live in the states that did not accept the expansion of Medicaid under the Affordable Care Act (ACA or “Obamacare”).   Of that number, an estimated 52,000 live in Idaho.  These are Idahoans who would have been covered under the ACA, but missed the opportunity because of the Idaho government decisions to not accept Medicaid expansion dollars and to sponsor its own individual exchange.  (Whatever the exact number, it includes some or all of the 78,000 in the Idaho Coverage Gap.)

What are the health impacts?  The study sponsored by the Harvard School of Public Health concludes that the availability of coverage in Massachusetts (the model for the ACA), has had the effect of improving public health reducing mortality rates.  While demographics and health care resources in Massachusetts may differ from those of Idaho, it is significant that a well-constructed, scientific study has concluded that 830 human adults obtaining previously unavailable health insurance coverage could prevent at least one death per year.

The next step is my own analysis of this data and required mathematical extrapolation. It is indicative only (meaning that it is simply an illustration) of the logic at the beginning of this post and my last post.

My analysis assumes that if the AHCA is passed by the Senate after the July 4th recess, its impacts would apply equally across the Idaho population, which represents around one-half of one percent of the total U.S. population.  It assumes that Idaho on its own does not find a way to close the Idaho Coverage Gap. (Efforts so far have failed.)  And, it assumes the Harvard Study results could apply to Idaho across the board to all who lose coverage. With those assumptions:

  • Between 125,000 and 150,000 people will lose coverage in Idaho within the next decade.
  • Between 150 and 180 people are more likely to die as a result.

This analysis has been dismissed as “hysterical.”  Our own Congressman, Mr. Labrador, attracted national and international news coverage when he said that lack of access to health insurance does not result in death.

Paul Ryan has also tried to spin the CBO data by saying that the “loss” of coverage under the AHCA is simply people opting away from buying health insurance in the absence of the “freedom robbing” mandate.

His argument ignores the fact that the largest negative impact on coverage under the AHCA is Medicaid contraction.  His argument is also like someone in the Medicaid gap saying he or she would choose to buy a BMW but exercises the freedom not to do so.

While I am aware that we live in a world of “alternative facts,” please understand that I have done my best to discern and share sound logic and credible facts.

Please encourage others, including our Senators, to do likewise.

 

Author: jerrysturgill

Leader, lawyer, banker, dad. Trying to make the world less bad.

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