Repeal and Replace
Yesterday, the House of Representatives passed a bill that no one has evaluated and few had even seen that “repeals Obamacare”. Of course, the Senate must pass a similar bill in order for it to become law, but despite that not-too-small detail still to be attended to, President Trump held a Rose Garden gathering celebrating the House passage of the AHCA.
Clearly something big has happened. But what?
To start, I have never been an enthusiastic supporter of the Affordable Care Act . It has been flawed from the very start in my eyes because it was never about providing quality healthcare to the poor. It only passed with the support of Big Pharma, Big Medicine and the American Hospital Association. It always looked to the fact that one sixths of the American economy is directly related to health care and one third is indirectly related. The money mattered more than access to care for the poor. This is why 90% of Church Health patients haven’t been directly impacted by the ACA.
Obamacare only allows people to have health insurance in states that have expanded Medicaid and if your income allows access to a subsidy to buy insurance off the Exchange. If you make below 138% of the poverty level, then you can neither purchase insurance off the Exchange with a subsidy nor do you qualify for Medicaid in Tennessee. This means the poorest people get nothing.
The new law, whenever it emerges, if and when it does, will have a major impact in states that did expand Medicaid. It will also give states far more power in the ways they spend their Medicaid dollars, which could be good if used wisely.
One of the real problems in this whole debate is that if you supported President Obama then everything in the ACA was deemed to be good. If you didn’t support him then it was all bad. Neither position was ever accurate. The same will be true for whatever happens next.
I heard a congressman from New York praise the new impending law and its changes to Medicaid by saying that he never understood why able bodied working people should get the same benefit for their healthcare as the blind and the disabled. What I think he has never experienced is the near-impossible cost of health insurance for people making minimum wage. Without the benefit of Medicaid, millions of people in America will remain uninsured. The real issue here is poverty, not healthcare and how we in America are prepared to respond to this cancer.
Most people only think about healthcare when they need it. For the most part that is a good thing. But it is not good for us to continue to live unhealthy lives and expect the broken healthcare system to fix us when we are desperate. Sadly, this may all be the result of a capitalistic economic system. We reward winners and accept that many will be left behind. But is this really God’s economy? Doesn’t God call us to care for those who are least among us? Shouldn’t we as people of faith be advocating for everyone to live the life well lived and shouldn’t this begin in our faith communities?
I raise this question because it is more clear to me than ever that we cannot depend on the political or economic system to provide the needed healthcare system for the poor. At least not in my life time. The only way the poor will be adequately cared for is when communities decide they will care for their neighbors and see everyone as their own. This is why Church Health will today do what we did yesterday and the day before and will do the same next week. Nothing has changed in our mission.
I am confident that the work we do is what God expects us to be doing. I will be praying for wisdom in Washington, but I will continue working to care for the next person God has put in front of me who has been left behind by the system.