Obamacare (ACA) Lives On!

Today brings the summer solstice! 2021 is almost one-half over. While the days during the pandemic seemed to drag on, now as we emerge like butterflies from our lockdown cocoons, slowly removing our masks and unfurling our tentative wings, we can begin to grasp onto the wonder of the seasons and watch the days fly by. And, although the West is undergoing record-breaking heatwaves, and the South is being drenched by a tropical depression, we in Maryland have enjoyed a couple of beautiful days this week. So much so that I reached into my memories and pulled out a poem that seemed to mirror this beauty well. Here is a verse to enjoy as you read this blog today:

And what is so rare as a day in June?
Then, if ever, come perfect days;
Then Heaven tries earth if it be in tune,
And over it softly her warm ear lays;
Whether we look, or whether we listen,
We hear life murmur, or see it glisten …
―James Russell Lowell

This excerpt is from an epic poem written by the poet James Russell Lowell who lived from 1819-1891.

Moving on now –

This week, answering what was thought to be the final challenge to Obamacare, the Supreme Court, in a 7-2 decision ruled against the state plaintiffs (Texas and 17 other Republican states), noting that they could not demonstrate that they had ‘standing’ or were harmed by this law. President Biden has extended enrollment (SEP-Special Enrollment Period) into August due to the uncertainties of the pandemic, so sign-ups should increase over the next few months, Even though it has not been able to deliver all that was hoped for, this healthcare act has changed the lives of many Americans. The mere fact that Insurance companies can no longer deny healthcare coverage for reasons of pre-existing conditions is, to me, a significant factor. This regulation now needs to be extended to Medicare secondary insurances which are not part of the advantage plan; underwriting and denial of coverage are still allowed in this marketplace. Allowing insurance coverage for students and other young people until age 26 through their parents' plans is another huge plus in my mind. 

Extending coverage to the state Medicaid programs has also helped many. Although many Southern GOP-led states refused to join in the program, some (AR and LA) did. Often the eligibility for these programs is well under the level of the federal poverty programs so few can qualify. In some states coverage is only for mothers and children; seniors or solo males are not covered. The main argument seems to be that even though the Federal government would cover most of the costs in the early years, the states did not want the burden of proving the coverage down the road, calling such things unfunded mandates as they knew how hard it was to remove such programs, once established. For seniors under the poverty line, Medicaid often supplemented the 20% of medical costs that Medicare did not cover; for those without Medicare, drug costs were frequently covered.

The Kaiser Family Foundation (KFF) noted in 2019 that there were still millions outside the healthcare system, some were immigrants who could not qualify for the ACA due to lack of legal status or eligibility issues, others could not afford the coverage or high deductibles, while others were unaware of proper enrollment issues. Immigrants or those on student visas could purchase insurance through the exchanges, as were newly minted citizens. Legal immigrants were barred for 5 years from participation in Medicaid, however. According to HHS.Gov, there are currently 31 million enrolled in the ACA or Medicaid expansion programs. That number is up from the over 20 million reported to be enrolled in 2019. In 2010, before Obamacare was enacted, there were an estimated 46-50 million uninsured individuals in this country. Today about 8% of those living in the US are uninsured (about 26 million).

I find fault with the costs of insurance in the ACA Marketplace. I do believe that the surrender to the Insurance industry unnecessarily complicated the program and I would rather have seen a government-run program of some type. The failure to offer a public option - that was killed by Democratic Senators in an attempt to get Republican approval (which was never coming) - was a tactical error on the part of Democrats. The choices for many families today are either reduced benefits or high deductibles, which are not adequate choices. I wish that there could have also been a mandate to reduce the high costs of pharmaceutical drugs. (I know the industry will point out the numbers of generic drugs whose costs are reduced, but costs for new drugs remain out of reach for those who do not have prescription drug plans.) So, until we can reach the goal of Medicare for All, I will support President Bidens’ proposal to reduce the Medicare eligibility age to 60. Medicare does not cover dental issues, eyeglasses, or hearing aids, so those programs should be included. And, of course, since dementia and Alzheimers are not covered and psychiatric illnesses get reduced benefits, that area needs reevaluation. We should stop penalizing mental illness.

The pandemic has vividly demonstrated the gaps in healthcare coverage. Weeks on ventilators brought huge hospital costs, some of which were covered by Federal programs. In the early days of the pandemic, KFF attempted to estimate the costs for the hospital care for COVID patients and just how many could be covered by current programs and how much additional funding was needed. What was the cost for uninsured patients who were hospitalized?   Even though coverage may not have been available to some patients, by law when an ambulance or other carrier brings a seriously ill patient to a hospital ER they cannot be turned away, regardless of status.

I doubt that we can ever truly know the costs of the pandemic. How does one estimate the costs for the loss of 600,000 people? What was the loss of talent and knowledge to our society? According to Statistica, slightly more than half of those who died were 74 or older, another 200,000 were between 50 and 74 which leaves about 100,000 deaths for those under 55. Additional information breaks the COVID deaths by race and is shown below. We have lost the collective wisdom of a generation of grandparents and great grandparents. What was the economic cost to our country as many small businesses closed their doors forever, taking with them the opportunities they had given workers in many cities and towns? What was the cost to families who lost the breadwinner or daycare services and had to rework their lives?  What is the cost t,o our children who spent a year mostly in virtual classes?  I doubt that they will regain the education they lost by virtual learning.

Most middle-class white-collar jobs could transition to a home office, but many service workers could not, so they continued to be out in the public and exposed to the virus. Those jobs are more often held by Black and Brown people and the death statistics bear that out. Covid deaths tracked by race demonstrate that Blacks had 178 deaths per 100,00 people, Native Americans or Alaskans had 172 deaths per 100,000, Hispanic or Latino 154/100,000, Hawaiian/Pacific Islander, 144/100,000, Whites 124/100,000, other and Asian at 97 and 95/100,000 respectively.

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Today Maryland announced that there were no COVID deaths in the state yesterday; that is a major milestone in the state’s recovery. The state full vaccination rate is only 53% however although partial rates are higher. CDC and other authorities this week warned about the increasing virulence of the Delta variant for the virus (the variant that devastated India recently). Although it currently is only 10% of the US caseload, it is expected to be the dominant variant within 6 weeks. Younger patients are highly susceptible to this version and have been hospitalized at higher rates than before. Although the President had hoped to reach 70% vaccination across the country, resistance in parts of the South and Western states remain, so that goal may fall short.

COVID stats – NY Times:

Total US Cases: 33,509,001. New cases: 11,138. Total deaths: 601,442. New deaths: 300.

Maryland Totals: Cases: 461,697. New cases 62.  Total deaths: 9,707. New deaths 4.

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This week saw the arrival of a new Federal Holiday. Juneteenth is now to be observed across the nation. I first heard of this holiday several years ago when it began to be observed in Montgomery County. This year marks the county’s 24th observation of this day. When I initially heard about it, I thought that the remote area of Texas which was the last to hear of emancipation was just far away and communications were poor. I was shocked to learn that slaveholders in Galveston and other parts of Texas just refused to admit the South had lost the war, did not recognize emancipation, and knowingly kept people in bondage for two more years after President Lincoln’s proclamation. So when a Union officer read the proclamation to the enslaved people in that part of Texas, there was great joy among that population. Today this holiday gave notice to the country that we should celebrate the day that slavery was finally ended. We have an opportunity to use this holiday to learn from the past and to rework our future to form a better more unified nation. Let’s not blow this chance!

‘Til next week – Peace.