I pray, for me and millions like me, that the Republican health care plan is not enacted. Here is what it would do to older people who rely on the Affordable Care Act.
I am 59 years old and have a chronic health problem that limits my ability to work — depression, which I realize is hard to understand until you’ve been knocked down by it. Based on a $25,000 annual income, I receive a $6,660 tax credit to help me buy insurance on the federal health care exchange. I pay $167 per month for a policy with a $2,200 deductible. I get a small subsidy to help with cost sharing, reducing my out-of-pocket maximum to $5,700. (Sadly, I might reach it.) I am enormously grateful for this help because without it I would be uninsured. That means no medication and no therapy to prevent, ameliorate and shorten the awful depressive episodes.
Under the Republican plan, after I turn 60, I would receive only a $4,000 tax credit — a cut of $2,660. But my premiums likely would skyrocket because insurers would now be allowed to charge older people five times what they charge a younger person, rather than three times under current law. Even worse, without the individual mandate requiring anyone who can afford it to buy insurance, healthy people would likely drop out of the market, leaving sicker older people in the insurance risk pool and driving prices higher and higher.
When I read about it, I thought, “well, maybe I could take the tax credit and buy health insurance for part of the year, drop it when I couldn’t afford it, and pick it up the next year.” But no. The Republican plan would penalize me, increasing my premiums 30 percent if I did not continuously maintain the insurance coverage I can no longer afford to maintain, effectively locking me out of insurance.
If my income drops, which is likely, is there a chance Medicaid will be there for me? The bill phases out Medicaid expansion after 2020. Maine has a referendum in November to use federal funds to cover the uninsured near or under the poverty line with Medicaid, like most other states do. It would be a great relief if that safety net were there for people like me. Not only does the Republican plan preclude that, but it caps Medicaid funding to the states so it cannot keep pace with expected growth in health care costs. This underhandedly erodes the entire safety-net program over time. God forbid I might ever need nursing home care.
Why are the Republicans doing this? Is it really because they want to repeal the taxes that pay for the Affordable Care Act? Their proposal does that and gives huge tax cuts to the wealthy. The major taxes to be eliminated are a 3.8 percent surtax on investment income and a 0.9 percent Medicare payroll tax for individuals with an annual income over $200,000 and couples making over $250,000. Altogether, the top 1 percent would get an average tax cut of more than $37,000, according an Urban-Brookings Tax Policy Center analysis. Their tax cut alone is more than my whole income. Meanwhile, my costs from this plan would be much more than the $2,660 and the premium increases described above. It could be my life. I have a dangerous illness that gets worse without treatment.
So, after repealing all the funding for the Affordable Care Act and cutting subsidies disproportionately on low-income and older people, how do they propose to pay for their more miserly tax credits? By cutting Medicaid for the poor. They are taking health care from poor and older Americans to give money to the well-off. The Republicans’ proposal is just so wrong. Forget politics. Reasonable people of all persuasions must stand up to this and other morally bankrupt behavior in Washington.
Mary Henderson is a retired legal aid attorney and health policy specialist. She lives in Topsham.