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Voices / Column

Affordable Care Act, we hardly knew ye

A baby-step in providing access to health care is about to die at the hands of Republicans in Congress

Dummerston

It took me until the age of 54, but finally my luck at avoiding a major illness and hospitalization ended in 2016.

I spent five days in March at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, N.H., after being hospitalized with what the doctors called an idiopathic autoimmune hemolytic anemia. Translation: my bone marrow hiccuped and stopped producing reticulocytes, or the good red blood cells, and my hemoglobin count got dangerously low.

The good news was that there was no cancer, no organ failure, and no autoimmune disease in my body. The not-so-good news: my bone marrow was in need of a kick start.

It took some heavy doses of prednisone (a heavy-duty steroid) and five pints of blood to counteract the chaos in my bloodstream.

I fully recovered from that scare in about two months. But then in July, a colonoscopy at Brattleboro Memorial Hospital — my first — found a large pre-cancerous mass that needed removal.

So in October, I was back at DHMC for the second time in six months, this time to have laparoscopic surgery to get about 1 foot of my colon taken out.

Again, I had a quick recovery. Thanks to the surgical team at DHMC, I am cancer-free.

* * *

Two major health crises in one year could’ve wiped me out financially. Together, the costs associated with treating both ailments totaled about $100,000.

Fortunately, I live in Vermont, a state that has fully embraced the provisions of the Affordable Care Act (ACA), which helps to subsidize the cost of my health insurance. My insurance that I got through Vermont Health Connect covered all but about $4,000 of the bill.

For people who are self-employed, or who work for businesses too small or too cash-strapped to offer health insurance, the ACA has been a godsend.

Yet Republicans in Congress are intent on repealing the ACA, despite the fact that the level of uninsured Americans has dropped from 17.1 percent in 2013 to 10.9 percent today.

They are intent upon repeal, despite the ACA making good on President Obama’s goal of slowing the rising cost of health care.

In 2009, the Centers for Medicare and Medicaid Services predicted health care spending would take up 19.3 percent of GDP by 2023. In 2016, it was projected to be 18.1 percent — which translates into more than $220 billion in annual savings.

The Republicans are intent on repeal despite several studies last year about the 20 million people who get insurance through the ACA.

The studies show that these patients were less likely to postpone care due to cost, less likely to have medical debt, and more likely to have a regular doctor and access to preventative health care such as vaccines and cancer screenings.

Needless to say, Republicans don’t have any coherent plan to replace the ACA. And the millions who now enjoy having the security of heath-care access — including thousands of Vermonters like me — will likely lose their coverage.

* * *

We know that the ACA is not perfect. Deductibles and out-of-pocket costs are still too high for many people, as are premiums, even with government help to cover costs. Too many states have too little competition (another reason for higher premiums), and consumers would greatly benefit from having a Medicare-style public option for health insurance.

Also, while the rate of increase in the cost of health care is starting to slow, the United States still spends more money on its health care than any other nation in the industrialized world. It also gets the worst outcomes.

But the Affordable Care Act has pretty much lived up to its billing. It has controlled costs while giving more Americans access to health care. In some cases, it is literally saving lives.

This is something that Democrats can be proud of, but I heard few robust defenses of the ACA from candidates during the 2016 election season. They allowed Republicans to control the narrative: to downplay the good things and exaggerate the negative, thus convincing voters that “Obamacare” is a disaster.

Now, the people who voted for Donald Trump and a Republican-controlled Congress — many of whom have benefited from the provisions of the ACA — might end up losing their health-care coverage.

* * *

The Affordable Care Act was a baby step toward the goal of joining the ranks of every other industrialized nation in the world that considers health care a right, not a commodity.

But the same forces that have opposed universal health care ever since Franklin D. Roosevelt first proposed it as part of the original Social Security Act in 1935 are about to take us backward.

And if the Democrats in Congress allow this to happen, along with all the other threats by Republicans to shred federal social welfare programs, they will deserve the scorn that will be heaped upon them.

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Originally published in The Commons issue #390 (Wednesday, January 11, 2017). This story appeared on page D1.

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