Crises have a way of bringing things into focus, and this country’s multiple crises are about to get far worse as far as ordinary Americans’ lives are concerned. With an all–but–guaranteed 6-3 conservative majority controlling the Supreme Court by January at the latest, it’s not an exaggeration to say this country is careening headlong into an inflection point like no other.
There are a myriad of unsettling changes to our society that will occur relatively quickly as a result of the right-wing Federalist Society’s stealthy takeover of our highest Court, but the most immediate may be felt in your trip to the doctor’s office as early as next year, as a health care system that was reasonably effective (if not ideal) to begin with is now, absent some unprecedented legislative intervention, on the cusp of being wiped out altogether for millions of Americans.
As Nobel laureate and economist Paul Krugman, writing for the New York Times, observes, no matter how good you think your health care is right now, your continued coverage, and therefore your health and that of your family, is now on the ballot this November.
If you or someone you care about are among the more than 50 million Americans suffering from pre-existing medical conditions, you should be aware that the stakes in this year’s election go beyond abstract things like, say, the survival of American democracy. They’re also personal. If Donald Trump is re-elected, you will lose the protection you’ve had since the Affordable Care Act went into effect almost seven years ago.
One out of every two Americans is saddled with something that some insurer at some point has deemed a “pre-existing” medical condition (for older Americans, the figure is about 86%). These arbitrary “conditions” can run the gamut of serious, life-threatening maladies to such common problems as asthma, diabetes and even acne. Historically, the nation’s insurance companies have never wanted to extend affordable health care coverage to people with such conditions for a very simple reason: it isn’t profitable. People with such health problems simply end up costing insurers more money.
As a result insurers have to be forced to provide such coverage. As Krugman explains:
[T]he fundamental logic of health policy says that if you want to protect pre-existing conditions, you either have to have the government provide health insurance directly, as it does with Medicare and Medicaid, or use a combination of strict regulation and subsidies to induce private insurers to offer coverage.
If all Americans were sterling examples of robust health, this would not be an issue. But as anyone who has ever de-planed in the United States after traveling just about anywhere else on the planet will immediately notice, Americans are among the most overweight people in the world, with an obesity rate of 36% as of 2017. With that fact alone comes a whole panoply of societal health problems, including conditions such as lung and heart ailments, on top of the many congenital and equally serious conditions which although “pre-existing” are fairly unpreventable for most people; often they are a consequence at birth or even a product of one’s environment growing up.
The Affordable Care Act (ACA or “Obamacare”) passed by a Democratic Congress in 2010, was specifically tailored to reconcile the unwillingness of health insurers to insure people with these conditions with the bare fact of Americans’ unusually poor health. As Krugman explains, one of the reasons for its success is its reliance on some fundamental principles: to protect people with pre-existing conditions you must prohibit insurance companies from discriminating against them. To do this you set minimum standards of coverage which insurance companies are bound by law to follow. To keep the insurance companies at the heart of the system profitable you also need to induce healthy people to sign up, and this is best achieved by providing subsidies to those least able to afford it. Absent a single-payer system which does not appear to be a prospect anytime soon, this is how the viability of Americans’ health care is sustained.
That is what the ACA (“Obamacare”) did, and as a result it has been relentlessly maligned and targeted by Republicans from the Tea Party to Donald Trump. Since they have been unable to eliminate it legislatively they have relied on the Courts, specifically the U.S. Supreme Court, and more specifically a subset of rabid, ideologue Judges, to attack the ACA in any manner possible.
With a 6-3 Court now looming, and with at least five of those in that majority likely committed to overturning the ACA, the long hoped-for moment for these people has arrived. For example, even as the November elections loom, Donald Trump’s Justice Department, now under the corrupt aegis of William Barr, has taken the rare step of joining a group of Republican states attorneys-general in a challenge to the ACA’s constitutionality that seeks to render the entire Act null and void.
That result would immediately yank health care coverage away from thirty million Americans. leaving them with no recourse. But for those who currently have health insurance outside the confines of the ACA’s exchanges, it would also eliminate the ACA’s prohibition on insurers denying coverage on the basis of pre-existing conditions, or hiking up the cost of such coverage astronomically.
Because the timing of the seating of any new Trump-appointed Justice is still uncertain, it’s not clear whether that decision would be rendered by an eight or nine member Court at this point. But even if the ACA is preserved that would not end the well-funded onslaught on it by the right. As Krugman notes, the only thing that can effectively prevent that is a proactive strengthening of the Act itself. And that requires a Democratic House, Senate and President:
So are Americans with pre-existing conditions doomed? Not if Democrats take the Senate as well as the White House. If they do that, they’ll be in a position to quickly reinstate an improved version of Obamacare soon after Biden is sworn in.
The COVID-19 pandemic is on track to kill approximately 500,000 people in this country by the conclusion of winter. For those half a million dead, the termination of health care benefits under the Affordable Care Act by a Supreme Court comprised of rabid anti-government fanatics would tragically make no difference to their fate. But one of the most alarming aspects about the SARS-CoV-2 virus is its sequelae; that is, its disturbing tendency to leave the people who survive it with debilitating medical problems long after the viral infection itself has eased. Some of the conditions of those who have survived a bout with this virus are outlined in this July, 2020 post by Deborah Grider, a Certified Clinical Document Improvement specialist tasked with formulating medical codes commonly used by Medicare to identify residual after-effect conditions in “recovered” COVID-19 patients:
In the United States, many practitioners are now seeing patients who were first diagnosed with COVID-19 in March or April still having symptoms. Some patients experience ongoing shortness of breath, coughing, fatigue, persistent chest pain on exertion, blood clotting (DVTs), poor concentration, cardiovascular complications, gastrointestinal distress, reduced muscle strength and impaired grasping power, dizziness, neurological complications, and/or conditions such as seizures or strokes, to name a few. Patients have even been known to develop post-traumatic stress disorder or depression. Recovery can be slow, incomplete, and costly, with a huge impact on quality of life.
Grider also notes that many practitioners are seeing permanent scarring and lung damage in post COVID-19 imaging of patients. But whatever the unfortunate after-effects occur to Americans as a result of the ravages of this pandemic, for millions COVID-19 is always going to be the “pre-existing condition,” used to justify insurance denials and rate hikes for years and years to come, well into the foreseeable future, and even if a vaccine is developed. As Krugman emphasizes:
So once again, if you or someone you care about has a pre-existing condition, be aware that your fate is very much on the ballot this year.
Krugman doesn’t even mention the residual fallout from COVID-19 infection. But he doesn’t need to.