This time “repeal and replace” is just repeal. And because it’s tucked away in the massive tax cut bill rather than being labelled as health care reform, Congress is hoping Americans won’t notice. Or that we’re suffering from protest fatigue. But quite apart from the concern I expressed last week that passage of the proposed tax bill will lead to enormous cuts in Medicare and Medicaid, the only plausible way to begin to pay for the planned handouts to corporations and the wealthy, there’s another issue: basic access to health care. Medicare, for all its imperfections, has for fifty years assured that people over 65 have access to medical care. Out-of-pocket expenditures have been rising as co-payments and drug prices have gone up, but the big-ticket items such as hospitalization are covered. The Affordable Care Act was intended to provide comparable access to medical care for the 47 million Americans without health insurance. While there are still millions without insurance today, the ACA has cut that number of 47 in half. The tax bill that will go to both chambers of Congress next week would eviscerate the ACA by removing the mandate to buy health insurance. The way that insurance works is by spreading the risk; if healthy people can opt out of sharing in the risk, the system collapses. Health care is no different.
The access to health insurance, and by inference to medical care, that is at stake is primarily an issue for people under age 65. But it affects those over 65 as well—if fifty-year-olds don’t have health insurance and get sick, they won’t be able to serve as the support system for their parents and grandparents. And the 62-year olds who were laid off and are unemployable because of their age will soon, if they can hang in there just a few more years, enroll in Medicare. If they've been uninsured for several years, they will likely enter Medicare in less than vigorous health. The effect will be an influx of sicker people into the Medicare program—placing a further stress on Medicare resources. So don’t let protest fatigue sink in—contact Susan Collins and John McCain and Lisa Murkowski and any other senator who isn’t ready to repeal the ACA, now, before it’s too late.