The Coming Republican Healthcare Nightmare–And How to Fight It

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The Coming Republican Healthcare Nightmare–And How to Fight It

Republican HealthcareMatt Kavanagh of Health GAP and of UPenn’s Center for Public Health Initiatives was arrested December 1 on World AIDS Day. (Pictured here in 2011)

Trump-empowered Republicans are planning to shut down Obamacare first thing next year, even though they say that people won’t lose their actual plans for two to four years. They’re also looking to change or cut Medicaid and Medicare. More than 100 million Americans are covered under one of these three plans, including the better part of the 1 million-plus people living with HIV/AIDS. What will happen now?

Here, Towleroad’s new counter-Trump channel Daily Resist talks with queer health activist Matt Kavanagh of Health GAP and of UPenn’s Center for Public Health Initiatives. He was among 11 activists who got arrested on Dec 1, World AIDS Day, for refusing to leave the premises outside House Speaker Paul Ryan’s office, bearing signs reading “Ryan’s Healthcare Dream is a Nightmare for People with HIV.” Here, he talks about how Republicans are planning to slice and dice health programs, what you can do to stop (or at least to slow) them, and how the changes might affect LGBTQ people.

What are your top worries?

MK: The 2017 House budget pretty much tells you what Speaker Paul Ryan and [anti-LGBT, anti-abortion] incoming health secretary Tom Price are planning–and it’s terrifying. They’re looking to block-grant Medicaid, turning it over to states so they can do what they want with it, reducing eligibility and coverage. It’s highly like that over time federal funding for Medicaid will decrease substantially. The plan is to get the federal government out of the business of providing health care altogether.

And if I were to play devil’s advocate and ask what’s wrong with that?

If you live in a state with a progressive government like New York, Massachusetts, California, Washington or Colorado, then you’re probably fine. They’ve already expanded Medicaid eligibility under Obamacare funding and they’ll likely want to maintain Medicaid as it is, putting in their own state money. They’ll also continue to prohibit discrimination based on LGBT or HIV status, which Obamacare now does across the board.

But if you’re in the 19 states that didn’t expand Medicaid under Obamacare, they’ve already signaled they’re not interested in serving poor or LGBT people or those living with HIV and they’re certainly not going to put up state funding. In those states, we’ll likely see the eligibility criterial for Medicaid going way up to exclude all but the poorest of the poor who also have disabilities or are pregnant. We’ll see the income cap on Medicaid plunge from somewhere around $30-40,000 currently back down to $10-20,000. That’s really scary. The federal government will no longer tell these states they have to provide a bare minimum of care.

All this likely would start happening in October 2017, which is the beginning of Fiscal Year 2018. And in those states, this means that if you lose your private Obamacare plan, you’ll also lose access to that expanded Medicaid funding.

States in red only give Medicaid to the very poorest with disabilities or a pregnancy.

Republicans are saying they’ll dismantle Obamacare immediately but let people stay on their plans for another two to four years while solutions are developed. What solutions?

Trump and his ilk have proposed allowing people to buy plans across state lines. But there is too much market failure in a totally privatized system. They’ll also repeal Obamacare’s minimum standards of care, states will regulate their plans differently, and it’ll be even harder than it is now for consumers to make heads or tails of different plans.

Obamacare also mandates that employers with more than 50 workers give them insurance, so we’ll be losing that piece of it, too.

And what about Medicare, which serves people ages 65 and up?

The Republican plan is basically to turn it into Obamacare, making it more privatized, where people over 65 get vouchers, kind of like the current Obamacare subsidies, and are left to the mercy of the open market. But older and sicker people haven’t done well on the open Obamacare markets. So many insurance companies have left the market because there are too many expensive sick people.

What are the specific worries for LGBT people?

Obamacare (formally known as the Affordable Care Act) outlaws discrimination based on many factors including sex discrimination, which the Obama administration has interpreted to include sexual orientation and gender identity. It’s the first time queer people have had national protection. Plans can’t block you because they suspect you’re at higher risk for HIV or for transgender-related services. That goes away when Obamacare is repealed.

This is a nightmare for people living with HIV, going back to relying solely on the Ryan White Act’s AIDS Drug Assistance Program (ADAP), which was so underfunded in the 2000s under Bush that hundreds of people were on waiting lists for lifesaving drugs in several states. Obamacare fixed that because it offered people with HIV total health plans, not just HIV drugs and care, and it used ADAP to pay their premiums. That won’t be possible anymore.

Is ADAP funding imperiled?

Yes. It’s part of Ryan White, which is discretionary spending, and the House Budget has said it wants to cut $100 billion from these kinds of programs that help poor people over the next ten years.

So other than people in progressive states and those with HIV hopefully still getting bare-bones meds and care…where will everyone else’s health care come from? The federally funded community health centers?

It’ll likely be more like the current situation is right now in Kansas with various publicly or privately funded organizations providing minimal care, which is great if you have the flu, but if you have cancer or a chronic condition, you’re fucked.

Is there any way to fight this pre-inauguration?

The Republicans are planning to use the budget reconciliation process to push these cuts through first thing next year, then again later in the year. They can’t be filibustered. We don’t have a lot of time. Right now we have to start making our electeds understand that it’s going to be incredibly painful for millions of people if they take these actions. Whether Obamacare stays or goes comes down to only about three Republican senators–likely the most moderate, Susan Collins in Maine, Rob Portman in Ohio and Pat Toomey in Pennsylvania.

Maine Senator Susan Collins (right) is among the few Republicans who can stop major harm to health programs.

How do we reach them right away?

On one hand, we need an outpouring of smart strategic citizen advocacy that lobbies them, writes letters to them, thinks about their motivations like being reelected and shows them we won’t stand by.

The other thing is direct action: These politicians are people and we can get to them and hold them personally responsible through creative actions. I loved when ACT UP covered Jesse Helms’ house in a giant condom. It calls out the bad actors.

How do you reach moderates and potential allies like Collins, though?

You appeal to them to do what’s right. LGBT people need to be standing right now with teachers, farmers, and small business owners, because a broad show of support for reps like Collins doing the right thing could be really powerful. They’ll likely be in their home districts over the holiday break, so just call to find when they’re in and go in and talk to them. That’s what they’re there for.

What should we be asking of Democrats right now?

They need to use every procedural process they have to stop or slow Republican movement. You can’t filibuster the budget reconciliation bill, but you can use it on everything else. As for budget stuff, Democrats showed rare backbone earlier this year when they conducted a day-long sit-in to freeze floor motion until there was action on gun control. Hopefully we’ll see more of that.

Republicans have ruthlessly obstructed Obama’s agenda the past eight years. Do you think Dems are capable of being that ruthless?

I certainly hope so. They’ve been far too accommodating. They need to finally stand up and fight, and if they don’t, we have to vote them out.

What do you read daily to keep up on health stuff?

The Kaiser Health News Morning Update. I also follow Kaiser’s Jen Kates. She’s great.

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