Health care in the age of Trump

Donald Trump is obsessed with obliterating the legacy of Barack Obama’s presidency in every manner possible. That includes the national health care program known as Obamacare. Much of the Obama-obsession seems personal, but the consequences of Trump’s efforts to eliminate or radically change Obamacare will have a far-reaching, long-term effect on the health and well-being of millions of Americans.

Some folks in this country seem to feel that everyone should be on their own as far acquiring health insurance is concerned. I’ve got mine, good luck getting yours.

There are many of us in this country, however, who see the availability of health care as a basic human right in what is the wealthiest nation in the world. The reason for that line of thinking is pretty simple. Without baseline health care children will suffer. Without baseline health care adults may not be able to work to support themselves and their families.

Without baseline health care people will still get sick, but they will be forced to turn in larger numbers to care in hospital emergency rooms. Hospital emergency rooms have staffs, equipment and supplies, which all cost money. When a patient cannot pay their bill for emergency room care, the hospital shifts it in some manner to the other patients of the hospital who do have health insurance, and also to government which pays for Medicare and Medicaid patients. In either case, other people indirectly subsidize some measure of the costs of uninsured care. In the age of Trump those indirect subsidies will grow.

During the presidential campaign in 2016 Donald Trump promised great health care for all, costing less than what people were then paying. He didn’t want people dying on the streets, he said.

When he got to the White House he joined with congressional Republicans in pursuing their dream of repealing Obamacare. Health care reform was going to be so simple. Repeal morphed into “repeal and replace,” except they could never figure out the repeal part, let alone how to replace.

After lurching from one alternative to another the House of Representatives managed to pass a repeal bill, but it died in the Senate. To this day Trump mocks the negative vote of the senator and war hero who cast a negative vote on a bill that would have killed Obamacare. That doesn’t seem to bother congressional Republicans who let the snarky comments about Senator John McCain go unanswered.

After “repeal and replace” failed, the Trump administration, with congressional assistance, proceeded to do all that it can to destroy the availability of health care for millions of Americans through the issuance of administrative regulations and by attaching partial repeal onto their tax legislation. They have fought Medicaid expansions in many states. They have eliminated the requirement that everyone must have health insurance or pay a tax penalty, which allows the healthiest to drop their coverage if they choose, driving up the cost of community-pooled coverage for everyone else.

In its place, Trump and his loyal Trumpkins have proposed the expanded availability of “short-term” policies to be sold in states that choose to do so. That option is what might be called “fake health insurance.”

A while back this year, when Roseanne Barr’s mouth got her new television show shut down, I pointed out an issue generally overlooked about the consequences of that show’s cancellation. While there were elements of Trump politics in the program, there was also an understory that was worth telling.

Roseanne and her TV family were middle class folks who had to pay their mortgage, put bread on the table and provide health care for family members. There were discussions about opioid-abuse, surgery deferred because of cost, pill-splitting and pill skipping – issues that millions of others deal with in real life every day.

It was only a TV show, but it highlighted how an average family struggles and can be destroyed by a lack of quality, reasonably priced health coverage. It often only takes one bump in the road to destroy a family’s budget.

An article in the New York Times earlier this week reported on one of the major consequences of a family’s health care problems, the growing number of people, particularly middle-aged and older, who wind up going bankrupt from a financial bump in the road that grows into a much more serious problem.

The short-term medical insurance policy option, according to the Trump administration, offers people low cost alternatives for health care. Wrong. Those options simply pretend to be health insurance. They are fake insurance.

“Short-term” originally meant 90 days. It was considered a bridge policy until a person could get into a more comprehensive coverage plan. The administration will now allow these plans to run for much longer terms, which creates the impression that they are like real medical insurance.

Here are some of the features of Trump-sanctioned short-term medical insurance:

  • The plans can now run for 364 days, with renewal for up to an additional 36 months.
  • Coverages often do not include prenatal and maternity care; mental health; drug treatment; prescription drugs; joint replacement surgery; cataract treatment; hernia repair surgery; injuries from organized sports; immunizations.
  • Annual dollar limits are imposed on the amount of care that will be covered. Obamacare prohibits such limits.
  • Pre-existing conditions will generally not be covered.
  • Strange conditions exist in some short-term policies like providing hospital coverage only if the admission occurs during the week.
  • Waiting periods are created for coverage to kick in.

Such policies can also come with high deductibles and high co-pays. Even worse is what doesn’t come with such policies – namely coverage for the ten critical health issues that are mandated by the still-in-force Obamacare law for standard insurance policies.

People who choose to buy short-term coverage may not need much in the way of medical care for a while, so they might not even notice what’s missing – until they need it. Some insurance carriers will gladly take them on. Policy premiums for short-term coverages provide much greater financial rewards for the companies and brokers selling the plans compared with what insurers and brokers make when selling insurance that includes the requirements of Obamacare.

Such flim-flam is something right out of the Trump University playbook. Promise people what they want to hear, take their money and laugh all the way to the bank. At the end of the day those buying into the fake insurance will likely be worse off than they were before. Let’s hope they don’t get sick.