It’s been one of the most talked-about issues this election season, and with good reason: Access to affordable healthcare affects everyone.
And, according to reports earlier this month, U.S. Senate Republican Leader Mitch McConnell is still considering the possibility of repealing the Affordable Care Act (ACA), also known as Obamacare.
“If we had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks … We’re not satisfied with the way Obamacare is working,” McConnell reportedly said.
Another reason Medicare and Medicaid, as well as Social Security, have come up at the federal level is because Republicans need to find a way to pay for the Trump tax cut and increased defense spending, and such government programs are on the chopping block.
So as America nears the midterm election next week, what would Michigan look like without the expansion of affordable, accessible healthcare granted under the ACA?
For one, more than 600,000 working individuals with low incomes would go back to not having healthcare as provided now through the Medicaid expansion, Healthy Michigan. At its peak, the program covered 680,000 individuals.
A report on the uninsured population of low-income adults living in small towns and rural areas of a state that expanded Medicaid through the ACA shows Michigan as one of the top 10 states with the largest decline (22 percent) in uninsured people in those areas, and the only state in the Midwest with such a steep decline. The next-closest decline rate was in Ohio, which saw a drop of uninsured residents of small towns or rural areas of 18 percent.
Asked why that was the case for Michigan, Gilda Jacobs, president of the Michigan League for Public Policy, an organization whose work focuses on economic and social equity policies, said simply, “Getting medical attention is expensive.”
She added that, prior to the ACA, people had to turn to the emergency room for healthcare of any sort, “which is very, very expensive,” she said, not just for people, but for hospitals. Many had a tremendous amount of uncompensated care, she noted, which increases the prices for people who do have health insurance.
In addition, people were getting treated “very late” for their medical needs, Jacobs said.
“There are a lot of folks that are working, doing what everybody expects them to do, trying to support their families, but they’re in jobs, or multiple jobs, that don’t have benefits. Healthy Michigan plans were able to address the needs of those families in affordable and accessible ways,” she said.
Secondly, nearly 4.5 million people in Michigan would also face the possibility of paying more for their healthcare or not having access to adequate care at all due to having pre-existing conditions otherwise protected by the ACA, including asthma, cancer, diabetes, Parkinson’s Disease, and more.
Also noteworthy is the lack of equal coverage for mental health, as the ACA created mental health parity when it came to that kind of healthcare.
“It’s a very important component of the Affordable Care Act. It’s hard to separate people with mental health conditions from the rest of their needs. We know that whether it’s opioid addiction, alcohol, (or) substance abuse, those are diseases,” Jacobs said. “For so many years, some legislators were hung up on the ideology that (mental health is) a character flaw as opposed to a medical condition … There’s a stigma that still exists for people with mental illness, and by having mental health parity, you reduce that stigma as well.”
A Michigan without the ACA would also mean that its young people – many of whom leave post-secondary education thousands of dollars in debt – would also be forced to find another option for healthcare while they look for work, or working an unrelated job simply to have healthcare, since they wouldn’t be able to stay on their parents’ insurance until they’re 26 years old.
And these are just a handful of reasons why the ACA has been good for Michigan, Jacobs said, as it has also created more jobs, ensured women did not pay more for their healthcare coverage (women historically had been charged 32 percent more for healthcare coverage than men for the same coverage, she said), and it keeps the economy moving.
“If you’re healthy, you’re able to work,” Jacobs said. “And people who have health insurance are more likely to take their children to the doctor when they’re sick.”
Asked why, then, some people – mostly Republican-affiliated – seem so bent on ending the ACA, Jacobs said she was “forced to think” it’s politically motivated.
“I think this is just one of those kinds of attacks on Obama or anything Obama liked that may have been successful. As soon as President Obama was elected, there was an effort made from the outset to try to discredit him and his governing moving forward,” she said. “The ACA, it serves people in poverty and not wealthy people. People in office right now seem to be, because of the tax cuts, more concerned about people in the higher income bracket than low-income bracket.”
Michigan also recently enacted work requirements for people on Medicaid – something she said she and her organization are deeply concerned about.
“The way it was crafted around whether the waiver was accepted by Centers for Medicare and Medicaid Services at the federal level is going to be extremely harmful. It was a law that was passed that, either intentionally or unintentionally, had dire consequences on low-income people,” Jacobs said.
Meanwhile, they will continue to watch what the federal government does to not just the ACA, but Medicaid, Medicare and Social Security – all of which Republicans refer to as “entitlement programs.”
Jacobs said, “When you reduce the pie, you reduce the ability of services to be paid for…We’re concerned on lots of issues, but most importantly, we want to be sure government programs that people need are still going to be there, and are still going to be able to help people.
“We hear stories about low unemployment, but in rural and urban areas, there’s still high unemployment; no public transportation; no adequate, safe, child care; and in Michigan, our education system is pretty broken,” she said, noting that children of color are also disproportionately affected by all the aforementioned policies.
So, what to do?
“The most important thing is people get out there and vote. Elections have consequences,” Jacobs said. “Voting matters. The people that are going to make decisions on our health, education, and safety are going to be the ones we’re electing or un-electing. Voting really, really matters.”