By KAY MATTHEWS
New Mexico Representative Steve Pearce’s staff locked his constituents out of his field office in Las Cruces last Thursday afternoon after they came to complain about the teleconference call he held where many people were also locked out. Angry constituents all across the country have been confronting their congressional representatives—and it will no doubt escalate this week as the congressional recess continues—in what is proving to be a real rise up against Trump and the Republican agenda.
Democratic Representative Ben Ray Lujan, however, met with his predictably partisan—and welcoming—constituents at the El Centro Family Health Clinic in Peñasco on Saturday to talk about the Affordable Care Act (ACA) and its imminent repeal. Lujan sits on the Energy and Commerce Committee’s health subcommittee that has held hearings on the proposed plan to “repeal” and “replace” the ACA by the Republican controlled congress. A hearing is scheduled for February 28 on the so-called replacement plan, which Lujan told the crowd consists only of a framework, not legislation, referred to as a synopsis of Speaker Paul Ryan’s “Better Way.”
Lujan went through the list of what they’re actually proposing, although without the actual legislation written out it’s subject to change and revision. As far as changes to Medicaid, the plan would impose either block grants to states or per capita caps on communities—most likely the latter—that essentially pass on the costs of Medicaid to the states. As Lujan pointed out, “The only way states are going to meet these caps will be to cut back on services.”
The plan would privatize Medicare with the issuance of vouchers to individuals, with out-of-pocket payments once the value of the voucher is exceeded. It would also increase the eligibility age beyond 65, although those people 55 years and older would be grandfathered in.
Coverage for those with pre-existing conditions, one of the most important aspects of the ACA, is said to be included in the plan, along with no annual cost caps per individual and an allowance for children to remain on their parents’ plan until age 26.
Other provisions included in the ACA, as well as proposals to improve it, are either left out of the Republican plan or their status is unknown. Insurance companies would not be mandated to have a base level of care. There is nothing about negotiating better drug prices or if the infamous Donut Hole for prescription payment will be excluded. Will there be provisions to support rural health care clinics? Will there be provisions to regulate insurance company charges?
The ACA provides tax credits to help pay insurance premium costs to those who qualify financially. I recently read that the Republicans were considering changing the tax credit from a financial criterion to an aged-based one. In other words, providing more financial assistance to older people because their medical needs are usually greater than younger people. This would mean that Bill Gates could qualify for a larger tax credit than the younger man who mows his grass. I asked Lujan about this and he said that to his knowledge that’s not part of the plan but that he would look into it.
Things got off to a rousing start when Lujan asked for questions and comments from the audience. A man named Paul Branch stood up and announced that this country is under attack by Donald Trump and we have grounds for impeachment. He got a ringing round of applause. After that, the discussion centered mostly on people’s experiences with the ACA, both good and bad (mostly good), specific questions about what to expect, and more philosophical questions about what the hell we’re supposed to do to protect ourselves against the privatization of Medicare and the diminishment of Medicaid.
Lujan encouraged folks to stay active and express their opposition to these proposals, quoting Abraham Lincoln several times: “Public sentiment is everything.” While everyone agreed this is critical, and suggestions were offered about how to get involved, the frustration about what options we really have was palpable.
Lujan acknowledged that what we’re up against is formidable. “I voted against 60 measures to repeal Obamacare during the last administration. Then it became, ‘repeal and replace.’ Now the word ‘repeal’ is not being used” as a PR tactic to soften the impact. He admitted that the ACA was “not perfect,” and that he had been a proponent of the Public Option that would have provided government insurance. The House passed this component of the ACA but it was ultimately left out of the bill. As for the criticism that more and more insurance companies are dropping out of the ACA market, he blamed the Republicans for creating an environment of uncertainly through their years of opposition. He also pointed out that in 2009 he co-sponsored John Conyers’ bill, Medicare for All, to join the rest of the industrialized world in providing single payer health care to all its citizens. (Apparently Conyers introduces this bill every year.)
On the more philosophical question of “What is their [Republicans’] problem,” Lujan diplomatically sidestepped an answer. Someone then asked about the fairness of Paul Ryan and Mitch McConnell’s health care coverage when they’re trying to cut back ours. When Lujan responded that Ryan is “a nice man but I disagree with his policies,” someone in the crowd called out, “He’s a Nazi!”
The Republican plan demonstrates that party’s disdain of “big government” by shoving costs onto states, by privatizing services that are rightly the domain of government—not for-profit insurance companies—and by rejecting a coverage mandate that in their mind abrogates the liberty of individuals. Without this mandate, which spreads the burden across the population, insurance costs will rise and more people will lose coverage (watch this video of a town hall meeting in Tennessee where a woman eloquently defends the mandate). This is their ideology. That they can come up with a medical insurance plan based on this ideology that is affordable and available to all is by definition impossible.