JOHN GEYMAN, MD FOR BUZZFLASH AT TRUTHOUT
Before his inauguration in 2017, Trump made this promise: "We're going to have insurance for everybody. People can expect to have great health care. It will be in a much simplified form. Much less expensive and much better". Now, a year-and-a-half later, it is time to test the validity of this promise. Without any question, it is one lie after another.
Republicans and the Trump administration have failed to repeal the Affordable Care Act (ACA) after multiple attempts, but have sabotaged it in a number of ways. What we now have is chaos and confusion throughout the system, increasing numbers of uninsured and underinsured, health care costs going through the roof, worse patient outcomes as more people forgo care they cannot afford, and increasing bureaucracy as private insurers game the system for maximal profits at the expense of patients and their families.
This summarizes some of the many ways that Americans are worse off than ever in this increasingly unsustainable system that is Trumpcare, which places unfair and cruel burdens on a growing part of our population.
Crises Throughout the System
These are some of the impacts of Trumpcare that put the US health care system in crisis.
1. Inadequate access to care
According to estimates by the Congressional Budget Office, there are 28 million Americans uninsured today, with this number growing to 32 million in 2019 and 41 million in 2025. Tens of millions more are underinsured, especially as the Trump administration has relaxed many of the ACA's requirements that have previously protected patients, such as banning insurers' denials based on pre-existing conditions and offering short-term plans just short of one year with such limited coverage as to be considered "junk insurance." Most of these short-term plans exclude coverage for preventive care, maternity care, mental health and substance abuse treatment, and pharmaceuticals. Some have annual deductibles up to $10,000 and copays up to 50 percent. Access to care has been further reduced by budget cuts to community health centers, Planned Parenthood, the Children's Health Insurance Program (CHIP) and mental health care.
2. Increasing disparities
Disparities in access to health care can be based on many factors, including age, race/ethnicity, socioeconomic status, gender, disability status and geographic location. They vary widely from one state to another. As one example, low-income adults in Alabama are almost seven times more likely than high-income people to skip care because of cost.
3. Unaffordable costs of care
There are no significant mechanisms to contain prices or costs of health care under Trumpcare, which was also true of the ACA. Both continue to rise at rates far higher than the cost of living, making health care unaffordable for much of the population. The 2018 Milliman Medical Index finds that the typical working American family of four covered by an average employer-sponsored preferred provider organization (PPO) pays an average of $28,000 a year for health care, insurance premiums, cost-sharing and forgone wage increases (for the employer contribution). That is almost one-half of the median income for families of four in the US of about $59,000, obviously a crushing burden compared to the other necessities of life, such as food and housing. People in their 50s who are admitted to a hospital end up with a 20 percent drop in their income that can last for years, even when they have health insurance.
4. Inadequate quality of care
Despite spending far more on health care than any other country in the world, the US continues to have major deficits in quality of care. According to the ongoing cross-national studies of the Commonwealth Fund of 11 advanced countries, the US still ranks last or next to last on access, equity, health care outcomes and administrative efficiency. There are many reasons for our poor quality of care, including large numbers of uninsured and underinsured, profiteering by hospitals, drug companies and other providers, the number of people who forgo necessary care because of costs, and big differences from one state to another in access to care. Privatized Medicare and Medicaid programs typically have lower quality of care as they emphasize profits over service.
5. Instability and volatility
Increasing consolidation through mergers of corporate stakeholders have rendered our system more and more volatile. As insurers buy up networks of clinics and hospitals, patients, even when insured, often lose their choice of physician and hospital as continuity of care goes by the wayside. As one example, UnitedHealth, one of the nation's largest health insurers, employs more than 30,000 physicians while owning 230 urgent care clinics and 200 surgery centers. As insurers gain a freer hand under the Trump administration, they are at more liberty to deny coverage and services, even to the point of questioning the need for emergency room visits.
6. Deteriorating safety net
In the aftermath of the GOP's tax cut bill in December 2017, the deficit has spiked, prompting Republicans and the Trump administration to make wholesale cuts in safety net programs. These groups are especially vulnerable and hard hit:
- Retirees, who have depended on long-term care insurance coverage for nursing home care now find most of these insurers leaving the market.
- Women, 40 million of whom are on Medicaid and typically are the primary caregivers of their children, are especially vulnerable to cuts in safety net programs. Despite this pressing need, the Trump administration has been reducing family planning funding, promoting short-term "insurance" programs without maternity coverage, cutting food stamps, imposing new work requirements for Medicaid and proposing policies that would raise rents for low-income families.
- Residents of rural areas are hurt because rural hospitals and physicians -- especially dependent on Medicaid funding and essential for access to lifesaving services, maternity care and care for chronic conditions -- have suffered under Trumpcare as the number of closures of rural hospitals continue to rise.
- A recent study by researchers at the University of California Berkeley and Stanford University has concluded that opposition to welfare has risen sharply among whites as racial anxiety appears to be driving conservatives' calls for deeper cuts in safety net programs.
As Americans increasingly suffer under an out of control, profit-driven system and as corporate stakeholders, their CEOs, shareholders and Wall Street revel in their gains, when will we shift our priorities to the needs of patients and their families?
This article was adapted in part from the author's soon-to-be-released book, Trumpcare: Lies, Broken Promises, How it is Failing, And What Should Be Done.