There are some nights when it keeps me up in a panicked haze. What if I get hit by a car while I’m running? What if I take a spill on my bike and tear some ligaments or, worse, have to take an ambulance to the hospital from some far flung road outside the city where I live? An x-ray? I’m eating lentils for weeks. Extensive bloodwork? Not going home for Thanksgiving this year. Cancer? My only recourse would be Chapter 7 bankruptcy and America’s most effective health care plan: a GoFundMe campaign. Sure, I have health insurance for now, but these grim financial hypotheticals are the things that keep you up at night when (Republican) lawmakers have spent nearly a decade telling you they are going to diminish your access to health care.
There have been many stories in the last year about the truly heinous toll repealing ACA would have on citizens and the unnecessary deaths that would follow. I won’t pretend my situation is anything like that of the tens of thousands of American families faced with life-threatening diseases and crushing, ruinous debt from medical bills. But I can tell you how a small and dumb accident can put a regular dude on the financial ropes in America.
In late 2009 I fell down some steps in my apartment and tore my knee open. I was 24, broke (but gainfully employed), and uninsured. I took a cab to the ER, where the very nice nurse who stitched up my wound—I needed over 50 stitches and local anesthetic, which, it turns out, is very expensive!—specified the hours she worked and told me to come in then so I would not have to pay even more money to have the stitches removed. The ER bill from the stitches—stitches, we’re not talking about chemo or open-heart surgery—nearly bankrupted me. I haggled with the hospital’s billing department for months to reduce the tab to a palatable number, which was still north of $2,000. This, I know, is miniscule in the scheme of things. But I was living paycheck-to-paycheck, saddled with student loans, and, as a recent college grad, had little-to-no savings. $2,000 was not an insignificant chunk of change. I suspect many Americans would say the same thing about $2,000.
That is what our pre-ACA health care system looked like: Falling down the steps can put you on the verge of financial ruin. And I’m one of the lucky ones. I did not have to deal with complicated surgeries, exorbitant prescriptions, or a protracted battle with an illness that necessitates impossibly expensive treatment. I’m just a lanky klutz who is always in a hurry. I literally fell down some steps.
This is where someone—Jason Chaffetz or some other freedom-and-liberty obsessed Republican, perhaps—might tell me to be smarter about my finances. That I had choices that led to my burdensome medical costs. That I should have made different choices to make sure I could afford a freak visit to the emergency room. Or that I did have the choice to purchase health coverage (which would have been so comically bad it probably would have only marginally reduced my hospital bill anyway).
After that, I got insured on what lawmakers and deep-pocketed health care lobbyists like to call the free market. And you know what? It’s not as magical as the GOP would have you believe. It was lousy, expensive, and the only thing it ensured was that my parents wouldn’t go bankrupt if I got hit by a garbage truck. I had a $7,000 deductible and a $239 monthly premium for catastrophic insurance. Shopping for plans, it seemed like no matter what I picked, I was fucked either way. The one I ended up with disincentivized going to the doctor and disincentivized preventative care. I once got a free flu shot out of pity from a Duane Reade pharmacist because they didn’t take my shitty catastrophic plan. It was bad and expensive coverage. Get ready for more of that.
There’s no denying that—despite its many flaws—the Affordable Care Act changed millions of Americans lives, including mine. I’m a bit of an accidental lab rat, in that because of my age and employment status (31, barely ever had a real job) I have an intimate understanding of the ways in which it was effective. I had a staff job from 2008-10 that did not provide insurance. (Dare I suggest you unionize?) I had a staff job from 2010-12 that did provide insurance. With the exception of my short employment stint, I’ve more or less bought my own insurance since I graduated from college in 2007.
Once the ACA was passed, I was able to stay on my parents’ plan for a very short time before I turned 27. (The popular provision that allows adults under the age of 26 to stay on their parents’ plan is not being repealed). Then, in my first year freelancing on what could be described as a modest income in an expensive city, I received a small subsidy ($28/month) to assist in paying for insurance I bought through the New York State exchange. When I made more money, I no longer got a subsidy. The market, though volatile and in the process of sorting out the kinks, worked. I was insured and, though my premiums weren’t necessarily affordable, I could go to the doctor if I felt sick. Single payer this was not, but for the first time in my adult life, I felt like I was actually insured as a self-employed American.
Economists and healthcare experts talk a lot about job lock. Basically, workers feel like they cannot leave a job or look for a new one because of the benefits package at their current gig. Our byzantine healthcare market has them stuck at a job offering lower wages or no upward mobility because if they leave—and tap into that entrepreneurial spirit conservatives preach about—they will lose their benefits. The ACA, at least in my experience, freed me from job lock. I stopped perusing job boards and instead focused on pitching editors and reporting longer stories. I was making good money as a freelancer—as much as I would have with a 9-to-5 reporting gig—and had decent health care through the New York state exchange. I didn’t need a job anymore. I talk to a lot of self-employed people (please don’t call it the gig economy) who gripe about their rising premiums but quickly admit that their lives and their coverage are remarkably better under the ACA.
Both of my parents are self-employed. Every fall, when the open enrollment period begins, I spend at least 35 minutes daily on the phone with my old man as we navigate the health care exchanges in our respective states, trading tips and warning of potential red flags. (The last 19 minutes of these calls are usually dedicated to complaining about why we’ll never see single payer in our lifetimes and how we would love to give Paul Ryan a massive wedgie.)
My life may be made more difficult by the pending ACA repeal but my folks, as my dad bluntly put it the other day, will be “fucked.” They are both 62. They are healthy. They exercise regularly (my mom is particularly insane and sometimes goes to the gym twice a day). But they will have to shell out thousands more annually on healthcare than they do now. If the ACHA is passed, my mom and dad—along with many older Americans who cannot afford to retire yet, haven’t reached Medicare age, or do not have employer-provided coverage—are effectively being pushed into a ditch.
Before March 31, I will have to pay Oscar $483.44 for my monthly premium. I have to spend nearly $6,000 annually on insurance with a $7,150 deductible. I will have to fork over $13,150 out of pocket before my health insurance kicks in. That is a lot of money. (My monthly premium in 2016 was $358.67 with a $6,000 deductible.) And, again: I’m one of the very fortunate ones. Am I happy sending nearly $500 to a company founded by Jared Kushner’s brother every month? No! Do I find my rising premiums to be increasingly unaffordable? You better fucking believe it! Am I often frustrated while navigating our healthcare system? It’s exhausting! I never know what’s next! But it beats the alternative. And it’s the cost of doing business. Americans with employer-provided health care often forget that the cost of their health insurance plan is reflected in their salary. Repealing the ACA will affect everyone, not just the self-employed and the poor and the elderly.
The Affordable Care Act is flawed. Democrats know it’s flawed; Republicans obviously think it’s a travesty forced upon the American public; Barack Obama wrote an essay in the Journal of the American Medical Association just last year talking about the myriad problems in his signature healthcare law. Yes, it’s a shitty, half-baked solution. But it’s a shitty and real half-baked solution to a real problem in real people’s lives that needs to be improved and tweaked, not repealed and replaced with some Ayn Rand-inspired tax cut masquerading as health care policy.
The story of the ACA is as old and boring as government itself: It’s legislation that takes work.
“It’s so obvious because every major piece of legislation is intended as a starting point to kick off a series of changes,” Andy Slavitt, administrator of the Centers for Medicare and Medicaid Services under President Obama, told Deadspin during his waning days in office this January. “And those changes occur in the private sector and then as the world moves on the legislation is intended to adapt to what works and what doesn’t and what changes and what feedback occurs. So nobody at the time the ACA was passed—nobody—felt like this was a piece of perfect legislation. Legislation isn’t like a Renoir painting where you say let’s finish it put it up on the shelf, right? I think you just have to step back and say here’s what’s working, here’s what can work better, and here’s what’s not working.”
The institutional Republican Party doesn’t want to work to make healthcare better, though. They want to repeal the Affordable Care Act because they despise the man it’s named after and because, they say, they made a promise. The thing is that if you’ve tuned into any town halls or read any of the countless stories coming from local daily newspapers about irate constituents, no one wants this. (Except rich people and congressional Republicans, who don’t care about you.) Paul Ryan’s plan is just a shittier version of Obamacare.
The tax on people who don’t purchase health care is gone. It repeals a tax on insurance providers that, according to the Tax Foundation, was “designed to collect $14 billion a year from the industry as a whole.” It repeals a tax on manufacturers and importers of branded prescription drugs (an estimated $2.8 billion annually!). It repeals a 10 percent tax on tanning salons. It cuts an investment tax—Democrats essentially raised capital gains 3.8 percent to help augment the cost of healthcare—and a .9 percent tax on annual wages over $250,000. The top .1 percent of Americans would get a tax cut of roughly $197,000, according to the Tax Policy Center. Cutting both the investment tax and the wage tax could cost $300 billion over the next decade. And in a move so tone deaf I actually screamed out loud, the new Republican proposal gives insurance company executives a tax break on salaries over $500,000. Representative democracy at its finest.
This is not health care reform; this is a roughly $600 billion tax cut that makes it more difficult and more expensive for low-and-middle-income Americans to get health insurance and gives people who don’t need a tax cut a tax cut. It makes life harder on the poor, and easier on the rich.
Republicans say this is about choice. If most Americans—including many of those who voted for Trump—had a choice, they would not go back to that high-risk, high-premium, shitty coverage world before the Affordable Care Act was passed. Details about the Republican’s plan are still crystallizing. But the consensus is: This Is Bad And Who Will Pay for It? Democrats hate it. The Freedom Caucus—arguably the craziest motherfuckers in Washington!—hates it. Breitbart hates it! But Paul Ryan and Mitch McConnell, America’s greatest hucksters and grifters (second only to our current president), love it, and we are living in an episode of The Twilight Zone and so it will surely get rammed through the House and Senate. And while the undead enjoy their tax cuts, millions of people will go back to weighing medical care against financial survival, shot by shot and step by step, hoping they don’t slip on a stair.
Bill Bradley is a writer and reporter living in Brooklyn. His work has appeared in GQ, Vanity Fair, and many other publications. Follow him on Twitter @billbradley3. Know anything he should know? Drop a note at firstname.lastname@example.org or DM him on Twitter for a way to securely contact him.