Friday, March 03, 2017

Abortion Rights and Religious Wrongs

The question of abortion rights hasn’t been getting much press lately. This is probably due to the Orange Tire Fire in the White House and his continual outrages drawing attention away from this issue. It is definitely NOT because the issue has been settled, far from it. However, there are a few arguments around the topic of a woman's right to choose that I would like to highlight.

POINT #1: ABORTION IS A MEDICAL PROCEDURE.
As such, the only people involved in this decision are the woman, her doctor, and anyone else she deems worthy enough to participate in this matter. Nobody else should be able to impose their will on the situation, especially a bunch of middle-aged guys in government.

Despite this, Republicans in Congress are considering H. R. 490, the Heartbeat Protection Act of 2017, introduced by Steve King (R-IA) and co-sponsored by Trent Franks (R-AZ). This bill amends Title 18, Chapter 74 of the U. S. Code by adding, in part:

Ҥ 1532. Abortions prohibited without a check for fetal heartbeat, or if a fetal heartbeat is detectable
(a) Offense.—Any physician who knowingly performs an abortion and thereby kills a human fetus—
(1) without determining, according to standard medical practice, whether the fetus has a detectable heartbeat;
(2) without informing the mother of the results of that determination; or
(3) after determining, according to standard medical practice, that the fetus has a detectable heartbeat,

shall be fined under this title or imprisoned not more than 5 years, or both.”

This is absurd. Not for nothing, but in many cases the fetal heartbeat is at a level that it can be detected before the woman is even aware she is pregnant, which means this bill essentially bans abortion. Period.

In addition to this, there is the matter of the exceptions. True, it makes exceptions for the life and health of the mother. However, these come after the fact. In other words, a physician must wait for an indictment to come down, at which point he or she may appeal to the State Medical Board ... and then this only delays the trial for up to 30 days.

In other words, this bill takes the Constitutional notion of “innocent until proven guilty” and chucks it right out the window by assuming the practitioner is guilty and putting the burden of proving innocence on that physician.

It’s nonsense like this that slows the progress of the pro-choice movement ... and this is intentional. Anti-choice activists are not really interested in the health of the mother, or the continued life of the fetus (if they were, then there would be a lot more resources dedicated to improving the lot of unwanted children after they are born ... but I digress). What they are interested in is a) imposing their particular moral code on the rest of the country, regardless of whether or not it fits the beliefs of everyone else, and b) maintaining the patriarchy that believes that women are just silly, empty-headed creatures, incapable of independent thought, the poor ducklings, so it is up to all the big, strong men to protect them and tell them what they need to do.

Look, the right of a woman to choose how she handles her own pregnancy is inviolable, in much the same way that she has the right to refuse further treatment for ovarian cancer, or to get a second opinion when told she has heart disease or diabetes or gout or any number of other maladies. It is a medical decision, and as such it should have the same doctor-patient confidentiality protections as any other medical procedure. This is a basic issue of individual privacy, which was settled by the Supreme Court in Griswold v. Connecticut in 1965.

POINT #2: THERE ARE TOO MANY ABORTIONS.
I agree with the anti-choice movement on one point: the number of abortions is too high, and we need to bring that number down. Where we differ is in how we would do that. The anti-choice movement seems to think that, if abortion is made illegal, then they will just go away. This is so far from the truth that it’s barely visible on the horizon. What will actually happen is that women will continue to have abortions, but in much less safe conditions.

There is a website called abort73.com which has a lot of anti-choice propaganda. One of the statistics cited was that “[t]he Centers for Disease Control (CDC) tells us that ‘from 1970 through 1982, the reported number of legal abortions in the United States increased every year.’" This comes from a study in which the CDC tracked the number of legal abortions. What the abort73.com web site fails to mention, however, is that this same study showed that “[f]rom 1990 through 1995, the number of abortions declined each year; in 1996, the number increased slightly, but in 1997, it declined to its lowest level since 1978.” Of course, being an anti-choice site, this didn’t square with their propaganda so they left it out.

The truth? The abortion rate has been steadily falling from a high of 29.3 abortions performed per 1,000 women aged 15 to 44 in 1978 to 14.6 in 2014. By comparison, the rate in 1973, when Roe v. Wade was passed, was 16.3 (source: https://www.guttmacher.org/fact-sheet/induced-abortion-united-states). This doesn’t stop the anti-choice movement from trying to spin things their way, sometimes being very ... flexible ... with their understanding of what the truth is.

For example, a document published by Georgia Right To Life appears to run counter to the above statistics when it states that “In 1996, 1,365,730 abortions were recorded, an increase of well over 100% since 1973, when the annual figure was 615,831, according to the U.S. Department of Health and Human Services.” Of course, these numbers are false. According to the CDC report cited earlier by this same web site, the number of abortions in 1996 was 1,221,585, or a rate of 314 abortions per 1,000 live births. Of these, 98.5% occurred before 20 weeks of gestation, and 88.2% occurred before 12 weeks of gestation.

It becomes clear, when looking at these statistics, that all the screaming on the right about “partial birth abortion” (which, technically, doesn’t exist) is just so much histrionics intended to get their base fired up. The vast majority of abortions are performed before 12 weeks of gestation, and almost all of them are performed prior to 20 weeks of gestation.

The much more important number, however, is the number of deaths caused by abortions. In 1972, the first year for which statistics are available, the case-fatality rate was 4.1 deaths per 100,000 abortions performed. By 1992, that rate had dropped to 0.7 deaths per 100,000 abortions. Furthermore, the absolute number of deaths from legal and illegal abortions in 1972 was 63, whereas in 1992 it was 10. (A note on methodology: there is another class of abortions known as “spontaneous” abortions, or abortions that happened with no medical intervention. However, prior to 1978 all spontaneous abortions were classified the same; from 1978 on, spontaneous abortions that occurred after 20 weeks of gestation were classified as stillbirths and therefore not counted in abortion statistics. This had effect of inflating mortality statistics prior to 1978, and this class of abortion was omitted from our results so as to give an apples-to-apples comparison).

Given these numbers, it becomes clear that the anti-choice crowd is not really interested in women’s health. If they were, they would be trumpeting these numbers from the highest rooftops as a victory, while maintaining that there is still work to do. Yet their focus is, instead, on criminalizing abortion again, even though the statistics bear out the idea that doing so will result in higher mortality rates.

Women are going to get abortions regardless. The idea is to reduce the number of unwanted pregnancies, thus reducing the overall need for abortions. But more on this later ...

POINT #3: THE AVAILABILITY OF A CHOICE DOES NOT AUTOMATICALLY IMPLY THE RESULT.
The anti-choice movement assumes that, just because a woman has a right to choose to terminate a pregnancy, then she will automatically do so. Not only is this a ridiculous assertion, it is insulting to women in that it assumes they are nothing more than compliant sheep, incapable of making decisions on their own and needing patriarchal guidance.

It even comes up in the arguments presented by the right. “What if your mother had chosen to abort YOU?” is a favorite question leveled at pro-choice activists, despite the obvious irony inherent in that question. The answer, of course, is at a) if she had, I certainly wouldn’t even be aware of it, much less have a problem with it, and b) it was her CHOICE.

Just because a choice is available, that does not automatically mean that the choice will be made. For example, I apparently have a Constitutional right to own a firearm (I really don’t, but that’s a topic for another rant entirely). However, I refuse to have one. Just because I have the CHOICE to have a gun does not automatically imply that I will avail myself of that choice.

It’s the same with abortion. Look, if anti-choice groups want to counsel women to not abort their babies, as long as they are compassionate about it and don’t resort to intimidation or guilt tactics, then I support these efforts 100%. The official pro-choice stance, in my mind, is that abortions should be legal, and that we should do everything in our power to make them unnecessary. Which brings us to the fourth point.

POINT 4: SEX EDUCATION AND ADOPTION.
It is extremely interesting that the same groups that so piously champion "the rights of the unborn" are also the same groups that refuse to consider anything that might prevent these unwanted pregnancies in the first place, or oppose help for these women after the children are born. Many of these groups base their ideology in religion, more specifically evangelical Christianity. Unfortunately for women, this same ideology holds that birth control is immoral, as is sex education.

This gives us a population of women who are ill-informed about sex, who aren’t really clear on how and when women become pregnant, or on how pregnancy can be prevented. Anti-choice groups seem to think that they can shriek “Abstinence!” then brush off their hands and walk away, smugly praising themselves for a job well done.

There are so many problems with this approach it’s hard to know where to begin.

First, the idea that teens are too young and impressionable to handle sex education is ludicrous. Teenagers are smart people, and their minds are like sponges, absorbing volumes of information each day. Granted, they often make stupid choices (I, for one, used to walk all the way around the outside of my friend’s pickup truck as it was going down the road), but giving them accurate information on contraception can only help the situation.

Contrary to what the right would have us believe, sex education does not encourage teens to engage in sexual behaviors ... their bodies handle that task just fine, thank you very much. However, sex education has been shown to reduce the number of teen pregnancies significantly, as well as the transmission of sexually transmitted diseases.

And as far as this “abstinence only” thing? It doesn’t work. Look, anti-choicers are trying to use a moral code going back a couple thousand years to stifle a fundamental biological urge going back MILLIONS of years. The urge to have sex -- to procreate -- is a basic drive; it is actually (in the biological sense) the reason for our very existence. We are here to further the species, period. Full stop. Everything else is just so much frosting on that cake. Trying to curb teen pregnancy by demanding abstinence ... well, it’s just not realistic.

Let’s say that a teenager has gone through a program of sex education, and practices safe sex, and is responsible with her partners, and does everything right, and she gets pregnant anyway. It happens. No birth control is 100% effective (well, abstinence is 100% effective when used correctly, but again, it’s not realistic), and accidents do happen. The condom breaks, or the birth control pill was not dosed correctly, or any number of other factors, and now there’s a baby on the way.

Let us further suppose that the National Right To Life or a similar organization has counseled this young woman in a thoughtful, compassionate manner. They presented her with the available options, including abortion, then made their case without resorting to scare tactics or trying to shame her, and she decided to carry the baby to term. However, she doesn’t want to keep the child, recognizing that she is not at all ready -- emotionally or financially -- to be a mother. What then?

The obvious answer is adoption. It is a wonderful way to do what is best for everyone. The mother, even though it is heartbreaking for her to give up the baby, can be assured that the child will be placed in a stable home with loving parents, which will give this child a strong start in life. Yet evangelical groups often refuse to provide any assistance here -- basically, they are only concerned with this child up until the moment of birth; anything after that is someone else’s problem.

If the anti-choice groups want to truly be “pro-life,” as they say they are, then they need to step up to the plate and actually promote life, not just birth. Again, given the religious affiliation of many groups,. They are in an especially strong position to provide these services.

POINT 5: RAPE, INCEST AND MATERNAL AND FETAL HEALTH.
In almost every piece of legislation drawn up by the anti-choice crowd, there are exceptions for rape, incest, or the life and health of either the mother or the fetus. While these are laudable, there is an unsavory side to these exceptions.

To begin with, there is the potential humiliation. For many rape victims, the rapist is someone well known and reporting the rape can have unintended consequences. Sometimes the women is economically dependent on the rapist. Sometimes there is a fear of retribution. Occasionally a woman has been so brainwashed -- by religion, by the rapist -- that she has been conditioned to view the rape as her own moral failing. In the case of incest, the rapist may be someone she has known her entire life.

This humiliation is often compounded by the treatment she receives at the hand of law enforcement. Many times women are just not believed, or are thought to be hysterical and overreacting. They are often subjected to invasive procedures intended to “prove” that the rape really happened.

While the idea that a woman should not be forced to bear the child of a rapist is noble, it misses the point. What the anti-choicers are basically saying here is that woman needs to justify her choice to them, to the government, and to the medical community ... and given the patriarchal nature of these institutions, this boils down to a woman needing permission from a man before continuing down this road.

Again, it imposes a patriarchal restriction on women and intimates that they are not capable of making such a monumental decision on their own. It requires women to come up with a “why” for their choice, a condition that is not imposed on men at any point. If someone wants to buy a gun, they buy a gun ... there is no official questioning as to the motive (some, myself included, would argue that there may be a justification for asking “why” on gun purchases ... again, for another rant). If they want a car, they buy a car. If a man wants a vasectomy, he is not questioned as to why he wants it, nor is he made to feel “less than” for doing so.

So the question now becomes, what do we do about this?

In my mind, it's very simple. We need to confront this issue on three fronts.

BIRTH CONTROL
I agree that abstinence is the most effective form of birth control which, when used, has a 100% success rate. However, it is also highly unrealistic. Young men and women should be given objective information about the various forms of birth control, covering the pros and cons -- from overall effectiveness and failure rate, to cost, to ease of use. They should also be educated as to the actual implications of having a child -- from the financial implications, to the effect on the social lives of the parents, to how it will affect their education, employment, and their own health.

This will also help to destigmatize sex. There are too many people who lack basic information about sex and human reproduction just because they have been indoctrinated to think about sex as something “dirty” or inappropriate. Providing this education will allow young men and women to be more open, to discuss these issues frankly.

It will also have the effect of destroying the forbidden fruit. How many times, when we were growing up, did we come across something that was forbidden to us, which only made us want it more? And how many times, when we finally did get that forbidden thing, were we disappointed because it wasn’t everything we had built it up to be in our minds? This is what happens with sex now. People are raised from the cradle to believe that sex is something mysterious and forbidden, which gives it a whole cachet of desirability ... and then we grow up and discover that it’s basically just plumbing.

RAPE AND EXPLOITATION
A small number (unfortunately, not small enough) of pregnancies occur as the result of rape. We need to include funding for programs dealing with the prevention of rape and sexual exploitation, including exploitation of minors and human trafficking. Again, it comes down to education in many ways. Teaching young people about rape, about the effects both in terms of legal ramifications for the perpetrator and psychological damage to the victim, will do more to halt incidents of rape than any other measure.

FAMILY ECONOMICS
We need to increase funding for programs such as Temporary Assistance for Needy Families (TANF), food stamps, and to not only protect, but increase the Child Tax Credit. It is the single mothers and families at the lowest end of the economic spectrum who are least empowered to deal with an unwanted pregnancy, or with the child that comes of that pregnancy. We must also increase funding for adoption assistance, both for the adopting family and the woman carrying the baby.

Abortion is a highly emotionally charged issue. It is something that needs to be handled with care and with respect for opposing points of view. However, that does not mean blindly accepting whatever bunk the religious right throws out there. We need to demand accountability from anti-choice groups and activists, and make them present actual facts instead of trying to scare everyone silly. Above all, we must protect a woman’s right to choose, vigorously and with great prejudice.

My two cents.

Thursday, March 02, 2017

The ACA and You

One of the things -- a primary mover, in fact -- that is driving this new liberal activism is the Republican Congress and their attempts to repeal the Patient Protection and Affordable Care Act, aka Obamacare. And as long as they can come up with something that works as well or better than the ACA, then I’m all for it.

I have little faith, though.

The thing is, though, that argument and debate, especially in the online milieu, have become so heated and vitriolic that actual facts are having a hard time getting through. Add to that trump’s very successful (so far) term as Distractor In Chief, as well as Sean Spicer’s gleeful willingness to tell the entire press corps to fuck off, and trying to get legit information on this topic becomes about as easy as raising the Titanic with a fishing pole.

Well, I’m here to help. What follows is a (relatively) brief guide to what the ACA is, followed by a discussion of Republican proposals to replace it. I am going to do my best to remain objective about all of this, but my natural snark is sometimes uncontrollable, so don’t be surprised and/or offended if I resort to calling specific members of Congress out as douchewhistles.

First, the ACA.

Basically, the idea behind the Affordable Care Act was simple: make it a requirement that everyone gets health insurance, even young, healthy people (especially young, healthy people ... we’ll get to that), and add some regulations that prevent insurance companies from gouging or denying coverage, and the end result will be better care at a lower cost for everyone.

The way it works is this. First, new rules are put into place that provide the following benefits that did not exist before:

People could no longer be denied coverage due to a pre-existing condition.Prior to this rule, I would now be ineligible for insurance (I had a minor stroke a few days ago, which immediately puts me in a category of high risk). It’s not that insurance would have been too expensive, it’s that I would not have been able to get it at all. Thanks to this rule, however, I can now get insurance if I need to (fortunately I already had insurance, so this isn’t an issue ... but in the past the insurance company could have dropped me altogether as a result of my condition).

In addition, prior to the ACA, merely being a female was considered to be a pre-existing condition and coverage could be significantly more expensive -- or denied altogether -- as a result.

Lifetime caps on benefits have been removed.There have been documented cases of people using up their lifetime benefits before they are out of diapers. Children born with severe abnormalities -- conjoined twins, say, or a severe heart defect -- could burn through their insurance caps in a matter of days, leaving them stuck for the remainder of their lives. The ACA removed this limitation.

Children could stay on their parents’ policies until age 26.Prior to the ACA, children were only eligible to stay on their parents’ policies in certain very specific circumstances, such as total disability or partial disability over a certain percentage, or if they were full-time students living at home. However, since most people in their early twenties are in no position to get insurance of their own for a variety of reasons -- unable to work at a job that provides benefits because they are full-time students, a lack of work and credit history, and so on -- this rule has proven to be one of the more popular provisions of the ACA.

Second, there’s the individual mandate. Republicans in Congress leapt on this as a way to derail the whole thing, claiming that it was an unconstitutional tax. Their argument was based on Article I, Section 8, Paragraph 1 of the Constitution which states, in part, that “[t]he Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises ...”).

Actually, their argument was not that the mandate itself was unconstitutional, but that the subsequent penalty for failure to maintain insurance was. And there was some validity to this argument. After all, the penalty was to be paid as part of an individual’s income taxes, and the IRS was the agency responsible for collecting the penalty, so this was enough of an argument for the Supreme Court to grant certiorari and hear the case.

Which they did, in 2010. In a 5-4 decision, the Court found that the individual mandate was indeed constitutional. This had conservatives furious, and they then put considerable resources into convincing the American public that it was a complete boondoggle. This was partially successful in that they managed to bolster this belief in the people who were already sympathetic, and they may have even moved the needle slightly among the people who were undecided. For people who were in favor, however, the Republican grandstanding and bellowing did nothing but further cement the view that the GOP was the party of old rich white guys who wanted everyone else to be as miserable as possible.

The other part of the mandate that did not get the press it deserved was that it would have the effect of lowering the overall risk level. Previously, young healthy people tended to skip getting insurance because ... well, they were young and healthy. If these folks were required to get insurance, however, that meant that the insurance companies would be collecting premiums from people who were extremely unlikely to have a need for that insurance, which meant that they could lower premiums across the board while keeping revenues stable, thus making insurance more affordable for everyone.

The result of all this was that the young healthy people continued to not sign up for insurance in droves, the premiums did not go down as much as expected, and the Republicans used this as a hook on which to hang their “Obamacare is a disaster” hat.

Unfortunately, the Court also granted the states the option to decline to participate in the exchanges and the Medicaid expansion (more on this in a bit)

Third, there were the subsidies. The idea here was that the government would help the poorest of the poor by providing direct subsidies for the purpose of obtaining insurance. Republicans wanted tax credits, but Democrats recognized that requiring poor people to pay the full price throughout the year and then get a refund was not realistic ... many of these people did not have the resources to make that kind of purchase in the first place

Fourth, the ACA created exchanges where the insurance companies could compete for business in each state. Theoretically this would drive down prices as companies competed against each other for subscribers. However, this was undermined by the Supreme Court decision that allowed states to opt out of the exchanges. In these cases, consumers had to go to the healthcare.gov website and spend a few hours smacking their monitor in frustration because it didn’t work ... apparently because the brainstems the federal government hired to build that website also built such engineering marvels as the Yugo, the Washington D.C. Beltway, and New Coke.

Fifth, the Medicaid expansion. The new rule was that Medicaid would be made available at no charge to people earning 138% of the federal poverty line for their family size or less. Again, though, the Supreme Court decision undermined this. As a result, there was a gap in which people earned too much to qualify for Medicaid, but not enough to actually buy insurance.

This gap was used by the Republicans as a talking point to demonstrate the failure of the ACA. Granted, it was kinda like throwing nails all over the road and then blaming everybody for having faulty tires, but whatever. Far be it from Congress to let facts get in the way of a good sound bite.

Despite all these setbacks and problems, the ACA went live, and as a result there are 20 million more people with insurance than when it all began. However, Republicans in Congress have spent every single day bleating about Obamacare being a failure, it’s killing people, there are death panels (which don’t exist), it’s driving people into bankruptcy (not true ... the number of bankruptcy filings due to medical expenses has dropped significantly for the first time in history), it’s causing premiums to rise (again, not true ... that is controlled by the insurance companies). They have also introduced something like 75 bajillion bills to repeal it.

Interestingly, President Obama himself told the Republicans that if they could come up with a better idea, he would sign it. Naturally, this was taken by the far right as proof that Obama is a Muslim atheist communist socialist terrorist foreigner from Kenya who is out to steal our women and rape our jobs, or something like that. I’m not really sure, it was just too absurd to follow.

In a normal world, the Republicans would have taken this as a challenge and crafted a bill to present for his signature. Even if it was so horribly crafted that there is no way he would sign it, they could have at least used it for publicity value to show that they were indeed trying to be bipartisan but that grouchy ol’ Nancy Pelosi was just being too mean and not letting them do their jobs.

Given that this was not a normal world, however, they decided to go with a different approach: squawk even louder about how horrible Obamacare was, and introduce another 47 gazillion bills to repeal it.

Which is where we stood on November 7, 2016.

All that changed the next day when Vladimir Putin and Mitch McConnell installed donald trump as President. Now the Republicans had unprecedented control over government: 33 state houses, 32 governorships, majorities in both Houses of Congress, and the White House. With this they were suddenly given the ability to implement their agenda pretty much unimpeded, and boy howdy did they ever hit the ground running.

The very first thing the new Congress passed was a budget resolution defunding parts of the ACA. They were on track to do a full repeal, but then a funny thing happened on the way to the inauguration: the American people got loud and told them to knock it off. More specifically, they demanded that no repeal happen until a replacement had been put together. And even though it galled Republicans to have to do something as grimy and plebeian as bending to the will of their constituents, they began to create a new health care plan.

Which they did. Sort of. It’s not really a plan per se, it’s more of a change in nomenclature to try to disguise just how royally everyone is going to be anally violated if this thing passes. It’s so bad that Paul Ryan and his cronies have hidden the plan in the basement of the House of Representatives and won’t let anyone see it (source: http://www.cnbc.com/2017/03/02/gop-obamacare-replacement-bill-hidden-in-congress-basement.html)

In all fairness, Ryan says that it is still under development (not his words), and that it would be premature to publicize the specifics until such time as they are nailed down. Fair enough. Here’s what we do know, or at least have reasonable confidence that we know, about certain provisions of the Republican plan.

Block GrantsApparently, Republicans love block grants. They want to reduce everything to block grants: Medicaid, TANF (Temporary Assistance for Needy Families), SNAP (Supplemental Nutritional Assistance Program) contributions, and so on. Which begs the question: what the hell is a block grant, anyway?

In a nutshell, a block grant is simply another way of allocating funds. Let’s take Medicaid. Currently, Medicaid is funded according to a formula called the Federal Matching Assistance Package (FMAP, because if it doesn’t have an acronym it’s not real). Basically this means that for every dollar a state spends on Medicaid spending, the federal government matches this with a dollar of its own. This open-ended structure allows funding to ebb and flow according to the actual needs on the ground.

Under Ryan’s plan, FMAP would be replaced by a fixed dollar amount that would be granted to the states. This amount could only be adjusted through legislation meant to address that specific need; otherwise the amount of money stays the same regardless. While this may be “fiscally responsible” (it really isn’t, but we'll let that slide for now), it means that states are then unable to cope with drastic changes such as a flu epidemic or a natural disaster (for example, in a September 19, 2005 report the Center on Budget and Policy Priorities estimated spending for disaster relief efforts alone in post-Katrina Louisiana, including increased Medicaid spending, to be between $150 billion and $200 billion over five years).

Health Savings AccountsOn paper, Health Savings Accounts (HSAs -- again with the acronyms) are a great idea. People can contribute pre-tax dollars to be used for medical expenses, including over-the-counter medicines, reading glasses, and the like. This is a fabulous benefit -- provided you have the financial resources to stash money in a tax-sheltered account. Unfortunately, thanks to conservative economic principles like trickle-down economics, fewer and fewer people have those resources to begin with, so these are not utilized.

Tax CreditsThe problem with tax credits is that they are a method of reimbursement as opposed to being a subsidy. Again, if someone has the financial resources to buy health insurance with no assistance, a tax credit is a ice little benefit. It does absolutely nothing to help those who can’t afford it in the first place, though, which is something that the ACA was attempting to address with its premium subsidies.

Continuous Coverage ExclusionThis is a particularly pernicious part of the Republican plan that has the potential to royally screw over millions on a semi-permanent basis. The way it works is this: under Ryan’s plan, people would receive generous tax credits and so on as long as they maintain coverage. If something happens, however -- losing a job, for example -- that causes someone to lose coverage, and there is a gap in coverage, then insurance companies would then have the ability to deny coverage for pre-existing conditions, or to jack up premiums to stratospheric levels, or any number of other consumer-unfriendly practices. But, with the GOP being more focused on the fiscal bottom line of insurance companies, this is seen as a win.

Essential Health Benefits StandardsThis is basically the minimum standard that all insurance plans are required to meet. Any health plan offered through either the state exchanges or the federal marketplace must cover the following:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
  • Birth control benefits
  • Breastfeeding benefits

These last two really get conservatives in an uproar because, you know, boobies and vaginas (GASP!). As a result, the new plan does away with these requirements and instead offers “guidelines” that insurance companies can choose to ignore if they desire.

Preventative Health Benefits StandardsIn addition to the essentials mentioned above, ACA plans are required to cover a list of preventative services (too many to list here) at no charge to the policyholder. The Republican plan would do away with this provision, allowing insurance companies to go back to the old days where they could charge co-pays -- or exclude these services altogether.

The fundamental problem with the Republican plan -- any Republican plan, really -- is that is makes very basic assumptions: that healthcare is a consumable good, that Americans are better served by being able to shop around for the best deal, and that more choices are better when it comes to health care. These assumptions are completely false, for a number of reasons.

First, healthcare is not a consumable good like a new refrigerator or a round of miniature golf. In the vast majority of cases, health care is obtained under circumstances that can sometimes be labeled as “dire.” For example, in 2012 I had to go to the ER for a torn Achilles tendon. I got a letter from the insurance company saying that they were not going to cover the crutches because, even though the hospital itself was in-network, the supply house from which they got the crutches was not and therefore were not covered. According to the rep I spoke to on the phone, it was my responsibility to do my research and specify to the hospital that I wanted them to give me crutches from a place that was in-network.

It should be pointed out that, at the time, it was around 1 AM on Christmas Eve, I was alone and had driven myself to the ER and therefore had to literally crawl across the parking lot because, you know, TORN ACHILLES TENDON, and temps were in the 20s. When I tried to point out that these were slightly less than ideal conditions under which to conduct market research, I was shut down.

It is situations like these that make it very easy to understand that obtaining health care services is not like getting someone to clean your house. Most cases involve the unexpected -- car accidents, a broken ankle on an uneven sidewalk, a sudden case of food poisoning. Expecting folks to research every possible scenario so they can specify which ambulance service they use to take them to a specific hospital and be seen by a specific doctor who participates in the plan, then telling the hospital which medical supply house, pharmacy, and outside professionals to use is just plain unrealistic. Yet Republicans expect people to do just that.

Second, health plans, with their coverages, exclusions, co-pays, deductibles, and so on are insanely complicated. In addition, no two health plans even have the same parameters, making it virtually impossible to do an apples-to-apples comparison. For example, one plan may have a $15 deductible that applies to scheduled office visits only and a $30 copay all other times, except for ER visits which have a flat $150 copay regardless of whether or not the deductible has been met, with a 10% co-insurance payment, but the co-pays go away after a $3,000 annual deductible for each individual in the family has been met, while another has a $50 copay on everything but preventative services and a $250 copay for emergency services (waived if admitted) with no co-insurance but a $12,500 deductible applied to the family as a whole but with a $400 individual deductible that must be fulfilled before the family deductible kicks in, and both plans have different requirements as to which out-of-pocket expenses are applied to the deductible.

How are you supposed to compare these two things, especially when you are essentially being asked to predict the future and determine what your medical issues are going to be for the entire year?

And therein lies the basic problem with the GOP plans. Despite the rhetoric and chest-beating, these plans do not have, as their primary goal, supporting the health of the American public. Rather, the main focus here is on giving the insurance companies a windfall, a portion of which will then be passed along to Republicans in Congress in the form of massive campaign donations.

It is vitally important that everyone reading this -- Democrat, Republican, liberal, conservative -- take a good hard look at what the GOP is going, and what they intend to do, and how what they want to do will be beneficial for almost nobody outside of the top 1%, then pick up the phone and call your elected representatives in Congress and tell them you are not going to support them gutting your health care.

We can do this, folks. Together we have stopped the GOP on numerous issues, and we can stop them on this ... but ya gotta be involved. Ya gotta be persistent.

Above all, you have to be LOUD.

My two cents.


And The Oscar Goes To ...

Yeah, yesterday's column? Um ... no. Yesterday I posted that I had undergone a change of heart, a radical shift in my political lean...