The Walking Dead

The current and completely unfit occupant of the Oval Office was wrong, as usual.  D.C. isn’t a swamp; now, it’s a Superfund site.  And like a plotline from a Troma franchise, its radioactive vapors keep reanimating the corpses of bad legislation, setting them free to defile once more.

The latest rough beast which went slouching toward Capitol Hill to be born was the Graham-Cassidy bill. This latest barely-failed repeal push, the unholy lab-child of Senators Lindsey Graham and Bill Cassidy, was rushed toward a vote without even the courtesy of a full CBO score. It was thankfully stopped before coming to full term.

However, the Center for American Progress, using the CBO score for the AHCA as a starting point, did some excellent work on damage estimates:  https://www.americanprogress.org/issues/healthcare/news/2017/09/18/439091/graham-cassidy-aca-repeal-bill-cause-huge-premium-increases-people-pre-existing-conditions/

And the Center for Budget and Policy Priorities broke it down further:

https://www.cbpp.org/research/health/like-other-aca-repeal-bills-cassidy-graham-plan-would-add-millions-to-uninsured

So, while Graham-Cassidy didn’t make it to the floor for a vote, how did we manage to get this close to losing the ACA yet again?

As you remember, back in July, the attempt at a straight repeal by way of the AHCA was thankfully aborted when six brave Republicans plus Lamar Alexander joined Democrats to defeat it.  

The current occupant of the Oval Office, enraged at the Senate’s failure to repeal his predecessor’s crowning achievement, responded by taking to Twitter and threatening to end the Cost Sharing Reduction payments, or CSRs, which would cripple the law and, by extension, the health care of tens of millions of Americans.

The CSRs are payments made to insurers by the Department of Health and Human Services which cover those insurers’ costs of reducing premiums and payments to some individuals who purchase health care through the ACA.

Or, as the man who reportedly wanders the WH in a bathrobe yelling at television sets calls them, “bailouts.”

The nonpartisan Congressional Budget Office scored the ending of the CSRs, as per President PeeTape McSphincterMouth’s tantrum threats, and the math was stark. 

Not to be deterred, Graham and Cassidy tried to rush through a new plan.  Why the rush, exactly?  Well, due to budget reconciliation rules which expire on September 30th, the Senate needed to act quickly if they wanted to pass this on their slim 52-48 majority.  Thanks again to the two persistent Senators Collins and Murkowski, they didn’t, and now Mitch McConnell has another sad.

So, given that the ACA is a life raft for the most vulnerable among us, how would its repeal have affected the people who depend on it?  Specifically, how would it have affected women, who, at approximately 54% of those insured, stand to lose the most?  I’m sad/glad you asked!  

To answer that, we have to look at what we faced during the Bad Old Days, and how the ACA changed everything.  So let’s pour ourselves a shot of Rodham Rye, sit back, and remember how it used to be in the Olden Times.

To start with, insurers used to have a pesky standard practice in place called “gender rating,” whereby women would pay more for health insurance than men for - get this - the same healthcare.  Kind of a pink tax, except, y’know, expensive and life-threatening.  Before the ACA, a whopping 92% of plans on the individual market practiced gender rating, costing women more than $1 billion annually for the same fucking coverage.

The ACA outlaws gender rating, giving much-needed relief to those who get the short end of the wage gap.  But that’s not nearly all.

One of the most lauded aspects of the ACA is that it She-Hulk-Smashed the ability of insurance companies to deny people coverage based on pre-existing conditions.  For women, pre-existing conditions included, but were not limited to:

* a prior pregnancy
* a C-section
* receiving fertility treatment
* breast cancer
* cervical cancer
* receiving medical treatment for domestic or sexual violence

Congratulations, ladies!  If you had ever endured rape and/or domestic abuse for which you needed medical care, you had what your insurer could categorize as a “pre-existing condition!”  Which could disqualify you from coverage for the effects of said rape and/or abuse!  WOO-HOO, FREE MARKET!

The ACA put into place 10 Essential Health Benefits (EHBs) which insurers had to cover.  These include pregnancy, maternity, and newborn care as well as contraceptive coverage (later dropped due to religious pearl-clutching and whargleblargling) and breastfeeding coverage.  That’s right - not only does the ACA mandate that private plans have to cover contraception, they also have to cover breastfeeding services, including pumps and mandated break times to pump milk for hungry babies.  (Fun fact: the current occupant of the Oval Office once melted down and literally fled from a lawyer taking a pre-scheduled break to pump milk in a courtroom.  According to sources, he completely lost his shit, shouted “You’re disgusting!” at her then ran out of the room on the day of a hearing where he was giving a deposition in a case involving a failed real estate project in Florida in which, naturally, his investors had lost money.  Anyhoo!

Before 1/1/14 - the date all plans had to cover these 10 benefits by - 62% of insured women did not have coverage for maternity services. Because being forced to bear kids = Your Womanly Duty As Decreed By God, but expecting help with care for them = Fucking Godless Communism Or Some Shit.

It’s not just baby-making/baby-avoiding services we should be focusing on, though, because we are human beings and not just fucking incubators.  Women are more likely than men to forego both preventive care and medical treatment due to often being poorer, not being able to take time off work, being a primary caregiver, being the parent in the family most often looking after the kids, and basically being a total badass and toughing it the fuck out.  When we shouldn’t have to.

But with the ACA, the CSRs and tax credits went a ways toward helping this.  Preventive care now includes mammograms, cervical cancer screenings, blood pressure screenings, depression screenings, and immunizations.  Some preventive services are free, and others are covered with no out-of-pocket costs to the individual.

Touching on maternity care again (because reproductive rights are economic rights, damnit), care to guess what percentage of plans offered maternity care on the individual market pre-ACA?  If you guessed 12%, take a drink.  Now take another because that is a depressing number and we need to take our comfort where we can find it.  

As for premiums, a full repeal, according to the CBO, would increase premiums by 25% in that same year, 50% by 2020, and double them by 2026. 

To touch back on what we would have faced specifically with Graham-Cassidy: that plan would have eliminated the ACA’s subsidies and the Medicaid expansion and replaced them with a temporary block grant to each state.  These block grants would have been below current federal funding levels, would have been fixed, and would have been phased out after 2026.  It would also have made draconian cuts to Medicaid apart from the expansion.  

It’s worth pointing out here that women outnumber men on Medicaid 58% to 41%.

As well, thanks to that block grant funding, states would have had broad authority to reverse protections for pre-existing conditions.  From the CBPP: “States seeking waivers would only have to explain how they intend to maintain access to coverage for people with pre-existing conditions, but they wouldn’t have to prove that their waivers would actually have to do so.”

And, in a gleefully grotesque display of misogyny, it would have both taken advantage of the block grants to work around abortion rights and stripped funding from Planned Parenthood: https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/09/22/the-health-202-cassidy-graham-s-abortion-ban-workaround/59c4196030fb0468cea81a6b/?utm_term=.c1803f99c88e

I’d like to leave you with something upbeat, but I’m going to leave you with this instead:

The gender pay gap for white women may be 79%, but women of color are hit even harder at 63% and Hispanic women hardest of all at 54%.  Women of Asian descent, making a whopping 84.5% of what white men make, would feel the hit from a repeal in their bank accounts the least, but women of all racial and ethnic groups would fare worse than men in those groups as a result of a repeal of the ACA because we are already making less for doing the same job.

Whether it’s a full-out repeal like Graham-Cassidy or a Grover Norquist-style bathtub murder by way of withholding CSR payments, any harm to the ACA would disproportionately harm women. It’s depressing to look at the possibility that victories we’ve managed to claw out of hostile ground might be snatched back from us after all our hard work.  

For now, repeal is off the table.  But always remember that as long as Republicans control the House and Senate, they are not going to stop.  At best, this is a temporary respite.  Conservatives will be back at this soon, with an eye toward repealing the ACA through budget reconciliation for either 2018 or 2019.

(202) 224-3121.  Keep that number handy.

Anna Maltese is a cartoonist, archer, and the greatest sword fighter in the North Valley Homeowner's Association.

Anna MalteseComment