Return to health care before Obamacare? That would be bad for the Valley

Dr. Sarah Sifuentes, of Kaiser Permanente Medical Center in Fresno, looks over a patient in a mock demonstration of a computer-based system using a doctor offsite.
Dr. Sarah Sifuentes, of Kaiser Permanente Medical Center in Fresno, looks over a patient in a mock demonstration of a computer-based system using a doctor offsite. Fresno Bee file

The Trump administration, which has long struggled between a desire to get rid of the Affordable Care Act and the political realities of doing so, decided to go for it Monday night. In a one-page filing, the Department of Justice said the 5th Circuit Court of Appeals should affirm a lower court ruling that Obamacare’s individual mandate is now unconstitutional, and that whole law is therefore invalid.

Republicans and Trump will argue that they don’t really want Obamacare gone, but that the law simply doesn’t support it. The reality, however, is that the administration is actively pursuing the ACA’s death when it doesn’t have to. The reality also is that if the courts ultimately do the deed, a split Congress will not be able to pass any kind of substitute.

That means the country will go back to a health care system similar to what we had, with no individual exchanges, with Medicaid expansion threatened, and with millions of Americans losing health coverage. Congress might be able to save some pieces of the ACA, such as coverage of pre-existing conditions, but that too would be a long shot.

Government-assisted health care plays a critical role in the central San Joaquin Valley, one of the poorest areas of the nation. Two local congressional districts are examples.

The 21st District, which includes Hanford, Fresno, Bakersfield and parts of Tulare County, has one of the state’s highest enrollments in Medi-Cal, the federal program. Democrat TJ Cox beat incumbent Republican David Valadao last fall for the seat, in part because Cox supported Obamacare and Valadao did not.

Slide east to the 22nd District, where Rep. Devin Nunes, R-Tulare, backed the House version of the American Health Care Act of 2017 (Valadao did so as well). The GOP plan would have shrunk Medicaid by 15 million enrollees nationwide by 2026. Medicaid is the government program that covers low-income children, adults, seniors and people with disabilities, aiding one in five Americans. In Nunes’ district, 313,000 people were enrolled in Medi-Cal as of January 2018. Of those, 74,000 would have immediately lost coverage, and all would have had their coverage impacted through loss of benefits or access to doctors. (Medi-Cal is California’s version of Medicaid).

Nunes did this despite the fact that his district has more people relying on government-paid medical assistance than almost anywhere else in the nation.

For years, Republicans have argued that Obamacare has been a failure. Here’s what life was like before Obamacare:

▪ People hated the health care system: Before the Affordable Care Act’s arrival, a vast majority of Americans wanted health care and insurance reform, including 82 percent in one 2008 poll. Why? By 2008, health care costs were skyrocketing and insurance plans covered less.

Now, Americans feel differently about their health care. Despite years of Republicans demonizing Obamacare, 50 percent of Americans look favorably on it, with only 37 percent having an unfavorable opinion, according to a Kaiser Family Foundation tracking poll. Ask about Obamacare’s specific features, and the numbers get even better.

▪ Premiums were going up rapidly: Remember the annual groan at the rising cost of your employer’s health plan? Between 2000 and 2010, average family premiums for employer coverage grew 8 percent per year — a perpetual burden on Americans’ budgets. In the past nine years, that growth has slowed to an average of 5 percent a year.

▪ Women paid more than men: Women buying insurance on the individual market before Obamacare were often charged more than men — a practice known as “gender rating.” Obamacare made that illegal.

▪ People were afraid to change jobs: Leaving a job to go out on your own is hard enough, but that leap used to also mean walking away from affordable premiums. For some, leaving or switching jobs might bring a greater risk; if you had a pre-existing condition, insurance companies could refuse to sell you new coverage. That fear of health-care consequences kept people bound to the job they had, a phenomenon common enough to have a name: “job lock.”

Add to those the other improvements that Obamacare has brought, such as Medicaid expansion, fewer hospital mistakes and reduced patient admissions. This is what Donald Trump and Republicans want gone.

It may be a political gift to Democrats, but it would cost Americans greatly.

Compiled from reporting by The Fresno Bee and Charlotte Observer