“Repeal and Replace” is a Lie, it is Simply “Destroy and Enrich”

There is an old political truism that one should never impute intent on the actions of one’s opponents; that they are honorable people with whom one has, simply enough, policy disagreements. This truism does not hold with the Republican ACA replacement – the American Health Care Act (AHCA) passed by the House on Thursday.


The AHCA is not a fix for the Affordable Care Act (ACA, ObamaCare), which does need fixing. Rather, it is a destroy and enrich act – ultimately stripping access to health care from 24 to 30 millions of us, and through tax cuts for the rich, further enriching our Gilded Class. The Republicans have shown who they work for, who they are owned by: the extremely wealthy.


What are the issues ?


  1. Who wins:


While all the provisions are not known – indeed we don’t really know what this bill will cost and the precise numbers who will lose access to health care as it was rushed through the House without analysis – and while the Senate will make some changes, here is what this bill looks like as of today.


Individuals making more than $ 200,000 or couples making more than $ 250,000 get tax cuts. Medical Savings Accounts will be protected from taxes, wonderful if you have money to save. The richer among us get Federal help for insurance premiums – the ACA capped this help for individuals making $ 48,000; the AHCA provides subsidies for individuals making up to about $ 150,000. Minimum benefits are now dependent upon what each state wants and the states may allow insurers to charge higher prices for people with “pre-existing conditions”. Do you realize that being a woman is a pre-existing condition in this absurd scheme ?


The young and non-women get lower rates from insurance companies. There is no longer any penalty for not having insurance.


You aren’t a woman and don’t want to have a policy that covers maternity care ? No problem. This bill allows such plans. Never mind that his kind of policy writing drives up the costs of health care.


Medical device and pharmaceutical companies will also see tax cuts.


  1. Who loses:


All of you who benefitted from the ACA; all who received subsidies to assist you in buying insurance. You lose.


Our elderly – anyone 64 years old or more – will pay up to 5-times the price that an 18-year-old pays.


Anyone with a “pre-existing condition” pays more. And what constitutes one of these conditions is amazing. If you are a woman, you have one. If you were ever depressed, you have one. If you had a baby, you have one. If you were drug addicted and sought help, you have one. Diabetes ? Sorry, you are out of luck. Hypertension ? Too bad. The funds set aside in an amendment to this disastrous ACHA are grossly inadequate to provide the premium support needed for those of us with these pre-existing conditions.


Medicaid will be turned into block grants and this will limit the amount of money available to provide services for our citizens. The result ? Cutbacks in eligibility. Cutbacks in services for things like the “pre-existing conditions” mentioned above.


Our hospitals will be inundated with people who can’t pay. Expect to see hospital systems go bankrupt. Expect to see our fellow citizens die because they can’t get care.


And of course, there is the assault on Planned Parenthood. This is an organization through which millions of low-income, working women get their health care. This is cut as well. It appears our Republican brothers and sisters are pro-life only as long as the “life” is in a woman’s uterus. After that, they clearly don’t care. Uterine cancer ? Cervical cancer ? Breast cancer ? You won’t be able to go to Planned Parenthood for help.


In summary, this bill has nothing to do with “fixing” the ACA. It is a mean-spirited attack on the health of working Americans. It is a vulgar grab for resources that will benefit the rich. It is the most regressive legislation in generations and it will cost some of us our lives.


This is what Trump and his minions are doing. As a physician, as an American, as a father, I am disgusted by the behavior of the Republicans and Mr. Trump. If my writing sounds extreme, it is only because what these men and women are doing to us – to you – is very extreme and must be called out.


Make no mistake, if this is enacted, people you know – maybe even your family members – will be hurt. These barbarians must be removed from office before they destroy our country.


Published in the Daily Item (Lewisburg, PA) on or about 14 May, 2017

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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