As vice president, I met with Americans all across our country. What they told me over and over is that the Affordable Care Act gave them peace of mind — that if they got sick, or if their child got sick, they could get care and not have to worry about going broke as a result. They no longer had to lay awake at night wondering: Can I pay for this treatment? What happens if she gets cancer? How will I feed my family and afford the care?
They told me that because when the ACA became law and health-care coverage was extended to millions of people, it meant we had finally decided, as a nation, that health care is a right for all and not a privilege for the few.
Republican leaders in Congress believe the opposite. And if they take that peace of mind away, they’ll have to look Americans in the eye and explain to them that they have to start worrying again.
Last week, Vice President Pence told the National Governors Association that the GOP health-care bill currently being debated in the Senate “strengthens and secures Medicaid for the neediest in our society.” Respectfully, that’s simply not the case. Their bill tries to deal with opioid addiction on the cheap, eviscerates the ACA’s Medicaid expansion and guts the ACA’s promise that care like maternity and mental health and substance-use disorder services must be part of any viable health coverage system. They want to drag us back to a time — not all that long ago — when Americans could be denied basic health care because they were unable to afford it. That’s the reality of where we are today and it’s enough to make your blood boil.
Now, I hear some folks say: But hospitals don’t turn anyone away from the emergency room. Before the Affordable Care Act, though, hospitals provided about $40 billion each year in uncompensated care. People who didn’t have health insurance or couldn’t cover their co-pays were putting off needed medical care and skipping out on preventive care altogether. That’s not a sustainable model, and we’re better than that. A health-care system built around emergency room visits isn’t a health-care system at all.
The ACA isn’t perfect, but the choices we made when designing the law flowed from a commitment to provide the best possible care to the most people. Compare that to Republican proposals, which the nonpartisan Congressional Budget Office has said will mean more than 20 million fewer people will have health coverage by 2026, and millions more will no longer have the same protections provided by the ACA.
Here are just some of the people who could lose access to care if congressional Republicans get their way:
More than 70 million Americans rely on Medicaid, including close to 2 million veterans. Medicaid, including the Children’s Health Insurance Program, covers 39 percent of children in America, 49 percent of all births, 35 percent of Americans with disabilities and 64 percent of nursing home residents, around seven in ten of whom are women. Rural hospitals would be hit especially hard by proposed cuts because they’ve benefitted most from the Medicaid expansion that has meant fewer uninsured requiring uncompensated care, and yet Senate Republican leadership is looking to cut Medicaid by about three-quarters of a trillion dollars.
Slashing the Medicaid expansion would affect over a million Americans who’ve used it to cover mental health and substance-use disorder treatment. The original Senate bill proposed spending $2 billion to address the opioid epidemic — a drop in the bucket when it comes to addressing a crisis that is ravaging communities and ripping the heart out of our country.
After facing an outcry, Senate Majority Leader Mitch McConnell increased that to $45 billion. But my longtime Senate colleague is, I believe, missing the point. You can’t take away comprehensive health insurance from people struggling with opioid addiction and then just throw $2 billion or, for that matter, $45 billion their way for treatment. Experts say we need closer to $183 billion over 10 years to provide those on Medicaid with treatment for addiction and to provide care for other illnesses that often affect those addicted to opioids. Americans in communities affected by this epidemic understand firsthand that the status quo is grossly inadequate. We must do more to address this crisis, not less.
A middle-class family getting health insurance through a small employer could lose coverage for maternity care, mental health care or substance-use disorder services. Under the Senate’s bill, they would bear the burden of paying for these services out-of-pocket or having to go without them.
The new bill would create two individual insurance markets: One in which insurers must cover people with preexisting conditions, and one in which they don’t. And you don’t need a Ph.D. in economics to guess what would happen next: Healthier, younger people would flock to the less expensive, unregulated market. Those remaining in the regulated market will be older and sicker, and their premiums would increase to the point that they could be left with an option for insurance that exists on paper, but not in practice.
If you’re young and healthy, maybe this bill means that you’d pay lower premiums. But the thing about life is that if you’re lucky, eventually you grow old, and, in the meantime, you don’t know what will happen next. In the blink of an eye, or in one phone call from a doctor, your outlook may change. And if, God forbid, you find yourself in that position one day, I hope we still have the ACA in place so you can have the peace of mind that comes with knowing that no matter what, you can still get affordable care.
Senator McConnell says there’s still time to make changes to the bill before it gets to the Senate floor. But it shouldn’t even get there, because his bill can’t be fixed. By denying that all Americans have a right to health care, it’s fundamentally flawed. And Republicans are underestimating the American people if they think a few changes to the bill here or there will convince us that this bill is anything but a big step backward.
In my 36 years as a senator, I saw my colleagues take plenty of hard votes. This just isn’t one of them. If Republican leadership wants to improve the ACA, let’s first come to an agreement that everyone should have health coverage. Then, based on that premise, let’s have a debate about how best to improve care and reduce costs. Let’s again make the commitment that in America, health care is a right for all, not a privilege for the wealthy.