Does AHCA Turn the Clock Back to Pre-Obamacare and Little More?

Had a chance to examine the “Republican American Health Care Act” or AHCA, as it’s now known? Only the American government can put together a series of words that are as fascinating as they are incredulous. I’ve written several pieces today to cover the House approval of the new healthcare bill and you can be sure there remains some uncertainty with future obstacles as it moves through the American legislative process.

Here are a few of the bigger points – and again, there are still a lot of opportunities for our elected officials to bleed over the Act with their demands. This is not a complete look at the bill – not by a long shot, but it does address the key concerns everyone’s talking about.

First, one of the big changes is that you are no longer required to have insurance and you won’t take a hit on your taxes each year. Tax credits are redressed, too, if you do have coverage.

Guaranteed coverage for pre-existing conditions is still built in, but there are a few elements that define that aspect of the rule. For instance, an insurance company can’t charge you more for a pre-existing illness, at least not directly. There are three specific waivers that are really the “meat and potatoes” of this bill and they speak to the pre-existing conditions confusion.

The big fact: your state can apply for any or all of these waivers. To get a better idea of what your state might or might not do, take a look at the current breakdown here.  You can see, in detail, what’s referred to as the Essential Health Benefits Benchmarks by state. It might give you some insight as to what to expect. Here in Mississippi, you can bet our governor has a far different take on the waivers than what the governors of California or New York might have.

Under Obamacare, or ACA, an insurance company could not refuse to issue a policy because of one’s health status. That requirement remains in the overhaul (or whatever Team Trump is calling it). Here’s where your state’s position becomes important:

  1. One waiver focuses on the applicant’s age and how much an insurance company can charge. As it is now, an insurance company can charge older policy holders up to three times more than what they offer younger policy holders. The new rules allow an insurer to increase that difference to five times – with a door left open for even more increases in the coming years.
  2. You may remember the huge debate surrounding required coverage with Obamacare. Insurance companies were bound to cover outpatient services, emergency medical services, hospital stays, pregnancy, pediatric care, substance abuse programs, mental health services, prescription drug coverage, lab services and a few other services. Birth control and “breastfeeding coverage” was also required, though I’m not entirely sure what kind of health coverage a breastfeeding mother would require. There was some controversy with a few of the covered services.

Your state’s leaders will now define the parameters as they are tasked with the responsibility of determining what essential benefits residents will have access to as part of their insurance coverage. I don’t know how each state views coverage for certain illnesses, but I do know that Florida has had one hell of a time dealing with the opioid drug crisis. Many of that state’s leaders are blind to the problem. These are the kinds of challenges that will have to be addressed – there are lives at stake and nothing will ever change that, no matter how many times you change the name of the law.

  1. Insurers will be able to raise their premiums if a person drops his coverage for any reason. If you drop coverage and don’t re-enroll within 63 days, you’ll likely get hit with a higher premium – and the insurer is free to increase it considerably. Here’s the problem with that:

In 2015, the Kaiser Family Foundation released a report, “Medical Debt Among People with Health Insurance”. (On a side note – the information presented is a perfect snapshot of the common challenges with healthcare in this country.) As part of the report, 23 people from all walks of life and with varying income and family dynamics were selected.

The goal was to find out how medical debt affects families, especially if they have healthcare coverage. Of the 23 people, 18 said they have had an illness that triggered an income loss. All said they experienced damaged credit ratings as a result of those illnesses. It didn’t need to be a financially catastrophic illness, either. All agreed that “much smaller amounts proved unaffordable”.

Of course, major health events triggered big problems, and for the “vast majority of those interviewed, the medical event associated with the debt also left the patient unable to work or prompted a working family member to quit or reduce hours in order to become a caregiver.”

Take one guess as to what happens next.

They can no longer afford to cover their insurance premiums.

They can re-enroll later, but if it’s outside the 63 day window, they face a punishment penalty for dropping coverage and now, there likely exists a pre-existing condition that the insurer is free to price into the policy.

So, what does all of this mean? Best I can tell, we go back to a pre-Obama healthcare world. That’s not a bad thing entirely, but there were some much-needed protections that were a part of Obamacare. It’s a tradeoff, but whether or not it’s worth it is something each person will have to determine for himself. Here’s an interactive Kaiser map where you can enter your state, age and a few other details and get a better idea of what to expect.


A Nation of Excuse Makers Bringing Our Kids Down

When a drug manufacturer sues the FDA because it’s worried about how FDA describes it, you know there’s a problem. Part of that problem is that by focusing on the smaller details, people will overlook the bigger societal problems. And these bigger problems are huge. When news broke a couple of weeks ago that the FDA was being sued over Methylphenidate, a common generic drug used for ADHD in kids, I wondered, “What’s next?”

Quick disclaimer –

This is a highly charged topic, controversial on every level and until we stop walking on eggshells in an effort to avoid hurting someone’s feelings, nothing will change. Also, there exists wildly conflicting reports on how effective/dangerous/addictive various drugs are that kids are taking, especially methylphenidate (Ritalin). With that in mind, I’m including more links than usual so that readers can explore the research for themselves and come to their own conclusions.

Let me be clear – this is nothing more than facts from reliable sources and my interpretation of how things are unfolding. There are kids who do benefit from the advances of modern medicine, but this much I know: this country does not have millions of troubled kids who need to be taking dangerous chemicals because they have behavioral issues or learning disabilities. Period. It’s my belief that when a parent brings a troubled kid into a doctor for him to “fix” him with pills, the first thing that doctor should do is drug test the parent. If Mom or Dad uses prescription drugs to cope, then the problem becomes quite clear.

Take what you want from this and leave the rest. It really is that simple.

First things first – because it is so controversial and there are billions at stake for “big pharma” and countless others – including a sickening number of lobbyists in Washington – here’s a quick look at the problem:

According to the FDA, more than 10 million children in the U.S. have been prescribed psychiatric drugs so dangerous that medicine regulatory agencies in Europe, Australia and the United States have issued warnings that antidepressants, for example, can cause suicide and hostility in children and adolescents. Stimulant drugs, such as Ritalin and Concerta can cause suicidal as well as violent, aggressive and psychotic behavior, and that these same drugs can cause heart attacks, stroke and sudden death.

And here’s a real gem, one that’s as heartbreaking as it is shocking:

Children 5 years old and younger are the fastest-growing segment of the non-adult population prescribed antidepressants in the U.S. Children as young as 4 have attempted suicide while influenced by such drugs and 5 year olds have committed suicide. Between 1995 and 1999, antidepressant use increased 580% in the under 6 population and 151% in the 7-12 age group. The FDA ordered that a “black box” label be placed on antidepressants warning that they can cause suicide in children and adolescents. Remember though, they didn’t change the guidelines or acceptable uses (that should tell you everything you need to know about the drug companies and our government).

So where did this start? When did mothers begin giving birth to a generation of troubled kids? One thing is for sure: this problem didn’t exist in the 1940s and 1950s. Has anyone stopped long enough to think that through? Maybe part of the answer lies in the old saying that you can’t miss what you never had. But to fully grasp it, you have to compare and contrast.

The 1940s were tough, no doubt. Our country was doing its best to pull out of the Depression. War was at the forefront and families lived in what amounted to paper shacks. But there was pride in those shacks. There was the solid work ethic, the commitment of not just surviving, but thriving, within those walls and between family members. Moms didn’t take kids to doctors to “fix” them, instead, doctors came to schools to ensure the little ones weren’t suffering from some spinal problem due to a lack of vitamin C. The sniffles were just that: a simple head cold that didn’t require a week out of school and visits from social workers.

Kids dug potatoes after school instead of resorting to other activities, such as wreaking havoc on the streets. They weren’t ill-behaved because they were disciplined. Everyone struggled. There was pride taken in the efforts of husbands and wives who sincerely loved one another. They stood next to each other, even in the darkest times. They were an example for their children. They were in it together. Life was brutally hard – harder than anyone in our society can even begin to fathom. The lack of finances, the fear of the unknown, the prayers that a rain storm didn’t come through before they could strengthen their homes, the war that could escalate at any time, the hope that they can buy their children one pair of shoes before school started – all of these fears and worries – and yet, antidepressants and other drugs were never even considered. Even if they existed, you can be sure parents would have put their collective foot down and said, “Hell no. He’s a growing boy. He’s supposed to be mischievous and rambunctious and energetic and inquisitive and curious.”

And by the way, the parents weren’t taking prescription drugs either (the use of drugs like Ritalin in adults has doubled in just five years). Moms weren’t loading themselves down with ADHD medication to lose a few pounds (most moms went hungry each day to ensure her children had enough to eat) or to cope with her children (that’s because they were doing chores, helping their neighbors or in the fields. That natural energy was put to good use). She needed to be alert. She had chores to do. A house, unpredictable walls and all, that she had to maintain. She had clothes to mend and vegetables to find in the community garden so that she could feed her hungry children after they’d been up since before the sun rose that morning.

There was controversy, jaw dropping admissions of the worst in human nature and dark, dark days. That goes back to that whole imperfect human nature thing never changing. At some point, something has to give. We live in a country with a government so twisted that no one has faith in the future of our nation. We have no faith in medical professionals (hell, they’re prescribing these drugs) partly because many are bailing, courtesy of the new government-forced healthcare laws, we have no faith in our education system: we have teachers molesting kids and that bizarre Common Core nonsense. The fabric of our society is shredding.

There is no longer a sanctuary for our families. Home is some imagined safe place to fall because it’s no longer real for many kids. Both parents work, but for too many, even when they’re home, they’re making beelines to the medicine cabinet themselves. And in the midst of it all, there is absolutely no happiness. When did that become acceptable? Worse, what happens when these kids grow up? Remember, you can’t miss something you never had.

All photos are courtesy of the Library of Congress: