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WASHINGTON — As Republicans confront the thorny realities of repealing and replacing the Affordable Care Act, groups representing patients with the most serious diseases fear those plans could return the US health care system to one in which sick people are not guaranteed health insurance.

It comes down to the individual mandate, the law’s most unpopular provision, which required every American to buy insurance or face a penalty.


Republicans want it gone. But if they nix the mandate, it becomes exceedingly difficult to keep the popular insurance reforms — including the requirement that health plans cover everybody, even people with costly preexisting conditions, without charging those people more. President Trump and other Republicans have sworn they would keep that provision, which ended discrimination against America’s sickest patients.

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  • Health care for people is not the underlying issue but who or which provider stands to profit the most. Selfish greed is a factor that leaves humanity to waste away without thought or compassion. As the needy gets poorer and the sick get sicker we grabble on and on until the grim reaper threatens to show up at our your doorstep. Then all hell breaks out, yeah!

  • This administration claims to be all about business and deals, but it seems that nobody’s doing the math.

    They want to trade the “onerous” mandate of the ACA, which inflicts relatively small monetary penalties for non-compliance, with the catastrophic consequences of the exclusion of large numbers of people who will not be able to afford private insurance from time to time, for reasons described in the article.

    In the years leading up to the ACA, millions found themselves locked out of the insurance market because of pre-existing conditions. Catastrophic medical expenses became the #1 cause of bankruptcy in the early years of the 21st century.

    In 2000, I myself developed a serious illness that lead to disability. My long-time insurer dropped me like a hot potato. In those days, insurers could do that!

    The only insurance I could get with my now-pre-existing condition was a national company whose premium for sick people of my age was $1250 per month (in today’s dollars, about $1740). My medications, which were not covered, cost an equal amount. So I was paying, in today’s dollars, over $3,000 a month. Bankruptcy soon followed, because even doctors run out of money when they can’t go to work because they’re sick.

    President Obama’s vision was to stem the tide of preventable bankruptcies due to illness. No matter whether you agree with his other policies, no matter whether you agree with the “how” of the ACA, the numbers show that it works.

    The burden that uninsured illness has on society is phenomenal. Think about it: If sick people don’t have insurance that they pay for (or that’s partially subsidized by you and me), then you and I get to pay for ALL of it. Doctors and hospitals have to adjust their rates to account for unpaid bills. So the cost of medical services gets driven up when there are a lot of people who can’t pay. Insurance premiums go up, because hospital charges go up.

    People who can’t pay for medical care often end up not coming in for care until they’re very sick, because they can’t afford regular visits. Diabetics, for instance, need regular medical attention, medications, devices…and they can get very sick indeed if not properly cared for. People who would otherwise be productive citizens with diabetes can lose their vision, their limbs, and their kidneys without proper care. Do the math!

    Before the ACA there was a lot of patient “dumping” going on: If a patient showed up in an ambulance, and didn’t have insurance, the hospital would just send them to a different hospital. The expansion of Medicaid in most states had a huge impact on decreasing bad debt, resultant bankruptcies, and dumping. Private insurance became much more affordable for working families. Many people who work two or more part time jobs, none that pay benefits, are able to purchase insurance on the exchanges. Do the math…..

    The real bottom line is that hurting healthcare hurts not only the people who end up uninsured, but also…well, it hurts all of us. We pay more in premiums. We pay more in taxes. And we pay in ways that most people don’t realize. For instance, good prenatal care prevents prematurity and its consequences, which include lifelong medical and learning disabilities. The math?

    One measure of the greatness of a society is how it treats its most vulnerable populations. If we are to make America great, we need to sit down, do the math, and understand that it’s not only a moral imperative, but an economic imperative.

    Do the math. It’s good for all of us!

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