ACA Replacement Bill - Feelings? Questions?

Yesterday, the House passed a bill to repeal and replace the ACA (“Obamacare”). The bill still needs Senate approval before turning into law. For more information, see articles covering the bill by The New York Times or NPR.

Rather than spin around on the politics, I’m asking a few “human” questions to our community:

  • Based on what you’ve heard… what do you feel? Frustrated, relieved, indifferent, scared?
  • What questions do you have? What are you confused about?
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I’m feeling rather hopeless, to be honest. Frustrated, scared, and confused as well, but ultimately hopeless. I’ve lost faith in the American public to do even rudimentary research on the issues, and an enormous number of people who this bill (if it passes the Senate, which it won’t) harms are going to laud it. They’ll justify it. They’ll praise the (largely) men who passed it.

The reason I feel so hopeless is that the tide of people voting against their own self-interest is only likely to get worse in 2018. More wealth activists will get into Congress, and more draconian bills like the AHCA will pass. They’re likely to even get support in the Senate (the upcoming Senate seats are stacked for Republicans to gain a few). As far as I can tell, Republicans have won, and won big. And ultimately, the reason I feel utterly hopeless is because so many people have decided that winning is more important than doing what’s best for the country and fellow citizens, regardless of cost.

Now, there will undoubtedly be people flooding this thread with “oh, it won’t be so bad” and “this is good for everyone!” Again, it makes me feel hopeless that even people with our disease can’t parse a bill like the AHCA to see how harmful it is to them and those who suffer from the same disease. And then I’ll feel even more hopeless when someone trots out the “well, healthcare isn’t a right and people should have to work for it” line. People suck, what can you say?


I feel worried about pretty much everything… I feel my son’s health is in the hands of a group of people who have never experienced not being able to afford their life-saving medication.

Saying that I’m anxious is an understatement! :frowning:


Horrified and angry and devastated for the many people who will be sicker and die from this. Also extremely fortunate on a personal level to have never had a gap in my insurance coverage, so none of my conditions can be considered “pre-existing,” but absolutely aware of how much privilege and luck goes into that. When I’ve switched insurers, before the ACA, I would get asked for detailed proof of that, and I know they were looking for even the smallest gap in order to deny me coverage for my diabetes. Also thinking about the years in grad school I had to basically pay out of pocket for all my prescriptions (which was about the same monthly amount as my rent) and had no access to the modern technology like CGMs (despite having health insurance, it covered very little), and how much my health and diabetes control suffered over those years in ways I’m still reckoning with (e.g. retinopathy). I’m sure I would not have been able to get my diabetes under control without my current good medical coverage. It makes all the difference. It’s why the ACA certainly wasn’t enough either, since bad insurance coverage like that existed, but this is going in exactly the wrong direction of ensuring more people will suffer that fate, not fewer.

The only thing I’m confused about is how the people enacting this can live with themselves, let alone celebrate over beers the fact that they are condemning people to preventable illness and death.

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I feel grateful that if all else falls apart and I find myself without insurance coverage I’ll hopefully be able to purchase the older insulins at Walmart for $25/vial. That puts me in a much better position than my friends who have two children with a rare blood disorder which costs thousands to treat every month. They have no Walmart option.


I admit I haven’t read the whole thing. What concerns me: States may decide not to cover pre-existing conditions if they choose not to. If states decide to cover pre-existing conditions such as cancer, the policies may cover the diagnosis of cancer, but not cover chemotherapy drugs. Extrapolating from that, they may cover diabetes, but not cover the medications. Chemotherapy drugs and diabetes medications are exorbitantly expensive. Ultimately, in my opinion, that is the same as not covering the pre-existing conditions at all. Unless of course the affected patients are very wealthy and can afford to pay for the medications and treatments. What a mess. I have yet to see anything the government gets involved in that does not get completely screwed up. (Just my opinion, and I seriously hope I read and interpreted this wrong.) I am still uninsured as there was no way I could pay the ACA premiums and continue to pay mortgage, utilities, food, and diabetes supplies. Being homeless and insured just wasn’t an attractive option for me.

Hopefully this will touch off a market crash because now most of us will not be able purchase meds and healthcare. Then leads to the prolonged Trump recession that is coming anyway.
Which might just lead to singlepayer/Medicare for all and we then become part of the civilized world.

But we must also keep in mind that the bill has only passed in the House. It still has to make it through the Senate.


The Center for American Progress, an independent non-partisan policy institute, recently published this analysis of the health care bill that passed the House yesterday. It’s published under the headline, Latest ACA Repeal Plan Would Explode Premiums for People with Pre-Existing Conditions.

This paragraph troubles me. (The emphasis is mine.)

Based on our analysis, we estimate that individuals with even relatively mild pre-existing conditions would pay thousands of dollars above standard rates to obtain coverage. For example, because an individual with asthma costs an issuer 106 percent more than a healthy 40-year-old, she would face a premium surcharge of $4,340. The surcharge for diabetes would be $5,600 per year. Coverage could become prohibitively expensive for those in dire need of care: Insurers would charge about $17,320 more in premiums for pregnancy, $26,580 more for rheumatoid arthritis and other autoimmune disorders, and $142,650 more for patients with metastatic cancer.

Even though I am now covered by Medicare, if this legislation becomes law, I think Medicare will soon become a target for the same corporate pillage and plunder. This is worrisome and we, as people with diabetes, need to take a long cold look at this issue. Forget about whose political team you identify with. Just look at the policy. Will it help or hurt you? Now is the time to look at the details. Don’t wait till it becomes law and wake up a few years from now and ask, “Where the heck did this come from?”


IMHO, this was about the most heartless, downright mean thing to come out of the House in a long, long time.

It left me about speechless, so thanks to Charles Pierce for providing some words:


I get my insurance through my employer, so have mostly been shielded needing to know much about the ACA. But I heard that some of the changes in this new bill that passed the house yesterday would impact those with employer-based health insurance.

The news was fuzzy on exactly what could be affected if a state got a waiver, but it sounded like if any state gets a waiver, my employer regardless of their location, could choose to follow that state’s rules. It sounded like not only pre-existing conditions could be affected but also minimum required coverage, yearly and lifetime limits? I’m not sure but just having those up in the air worry me.


The Esquire language is strong but I agree with the sentiment. I believe it is serious wrong-thinking that “blind, genetic luck is a demonstration of divine design.”

This legislation is so wrong on many levels. My biggest objection is that this is not health care legislation. It’s a tax cut designed to distribute $765 billion over ten years to the most wealthy in our country. This is a moral travesty, but – Go Team! :unamused:


I personally am horrified, dismayed, and taken aback at the sheer greed of the Republican party. If this bill passes the Senate, it effectively hands out a death sentence to many Americans. Walmart insulin only goes so far. The complications caused by poor BG control because we are forced to use what we can afford rather than what is most effective is absolutely horrifying. Many Americans will go back to the same old game, wait until something catastrophic happens, go to an ER and tell them we are uninsured. Get the little care the system is willing to disperse so they can legally get us out of the building and hope for the best. Then file bankruptcy. Survive another 3 to 6 months and repeat. So much for quality of life.


It looks like the current House bill removes ACA minimum standards and protections. It also allows selling plans across state lines. This sets up a situation where an employer can (or is likely to) purchase coverage for employees from a state with “minimum possible standards.” This could absolutely (and almost certainly will) include plans which exclude diabetes, pregnancy, cancer, etc. from coverage under “basic plans.”

More or less, it will create a whole new set of “tiered” plans:

  1. Rockbottom plans that, basically, cover nothing at all (they used to exist pre-ACA)
  2. “Basic Coverage” from Alabama (or some other deep Red state) that covers no pre-existing conditions, no pregnancy, diabetes, cancer, or other “chronic” (i.e., expensive) conditions, and has yearly and lifetime maximum coverage amounts
  3. “Plus Coverage” from the same deep Red states where you pay a surcharge on top of the “Basic Coverage” for whatever condition you might have (like Diabetes)
  4. “Cadillac Plans” pretty much just like now: the ultra-wealthy can pay for what they want, since they don’t have to worry about things like cost

Employers both large and small will have a pretty serious monetary incentive to choose Basic Coverage plans for employees from DR states with lax (or no) standards of coverage. The exceptions will be if you work in a “high demand” industry where personnel are hard to find: Silicon Valley; Biotech; Wall Street; etc. These kinds of industries will still offer Cadillac Plans as a hiring incentive. Of course, the kinds of people employed in these places don’t actually need employer provided Cadillac Plans since they can afford their own healthcare.

More or less, this is a signal from the GOP that they want the Good Old Days of American Healthcare back again: poor and old people can just die, preferably out of sight; middle-class people can become poor with a few medical catastrophes or a car accident; those with chronic conditions can suffer if they don’t have the money to pay for their care.


I work in the tech industry and their health insurance plans (even in SV) are not as great as you’d think. I have been through 4+ insurance plans in the past 10 years, none pay like the one my dad had as a United pilot. :grinning:

We pay a lot of money for them to not cover all of my medications, pay for my CGM 100% on my own, pay for my pump myself (they pay for most of the supplies). Anything they don’t cover, means that even when I pay myself, it doesn’t contribute to my deductible or max out-of-pocket. I’ve had procedures “pre-approved”, then they refused to pay later, etc. I know it could be worse, but it doesn’t feel “Cadillac” to me (whatever that means). But yes, you’re right that with a tech salary, at least I can afford to pay the difference.


Well, consider me corrected! I know that my Federal plan is expensive but very good, but my last university-offered plan was pretty poor: high premiums, high deductibles, low coverage. I guess even the high-demand industries are cutting corners on insurance. I can’t imagine that this current fiasco of a plan could possibly improve that for anyone.

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Lots of people are saying this bill is never going to pass the Senate looking anything like the one passed by the House this week, but after the 2016 election, I don’t say something could “never” happen anymore.

While many of us think, well, I’m not one of the few Americans on the ACA (Obamacare), I get my health insurance through my employer, or in my case, through my husband’s employer. But this AHCA eliminates the requirement that businesses of a certain size offer coverage. This would be my nightmare situation. As an older person not yet old enough for Medicare with a pre-existing condition (type 1 diabetes) I would be screwed. I already cut corners, skip and delay appointments, put off getting treatments prescribed and beg for insulin samples, because my coverage is so meager. Just my generic prescription medications alone besides insulin cost me almost $100/month. Yeah, I’ll take that expired insulin, thanks. And thanks to my friend who sends me strips.

If the individual mandate is lifted, then plenty of people won’t sign up for insurance, both employer-based and individual market. So what happens when they need to go to the hospital? Who pays for their care?

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Same thing as used to happen pre-ACA: declare bankruptcy and let the govt. pay the bills. It’s the worst sort of nearsightedness and shell-shifting going on, since it will necessarily raise premiums while reducing compensation, let taxpayers pick up the bill on ER visits, and force yet more inefficiency into an already terribly inefficient system. The only thing I think could possibly come good from this whole mess is massive support for single-payer under the next administration. That, of course, assumes the next administration might be sane, which is doubtful at this point.

And yes, you’re absolutely right: the Senate could pass this cruel and unusual punishment for the poor and sick given the madness that has taken hold of the electorate.

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It sounds like an excellent solution for the young and healthy.

However as we all know, we don’t stay young or healthy, & accidents happen even to the most fortunate.