Johnson City Press: Caught in the GOP's drug price donut hole

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Caught in the GOP's drug price donut hole

Judy Garland, Community Voices Columnist • Feb 3, 2019 at 7:30 AM

My husband is diabetic, and the price of diabetes drugs have gone through the roof in the last few years. For no reason except that the drug companies decided they could get away with it. Needless to say, we hit the Medicare drug insurance donut hole early in the coverage year.

What a relief for people like us and others who rely on expensive drugs to stay healthy that the donut hole, under Obamacare, is slated to be phased out by 2020. But wait! If Republicans have their way, the opinion passed down by Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas will stand and Obamacare, with the slated closing of the donut hole and our hopes for well-needed relief, will disappear.

Those of us on Medicare, because we’re protected by our beloved public program, don’t have to worry about pre-existing conditions, even for the supplements offered by private insurers because Medicare protects us against them, too. Except for our medicines, but Obamacare was set to correct much of that, unless Republicans can have their way. With Judge O’Connor’s opinion, should it stand, most other pre-existing conditions become vulnerable. Even those with employer-sponsored insurance because, before Obamacare’s protections, insurance companies had enormous power over hiring and on the chances of very sick employees keeping their jobs. Remember, Upper East Tennessee has the highest rate of people with pre-existing conditions in our country.

Twenty Republican state attorneys general filed the lawsuit heard by Judge O’Connor, their specific purpose of which was to outlaw Obamacare in its entirety, including the pre-existing conditions protections. They argued the fact the Republican-led House of Representatives had repealed the individual mandate earlier this year should make the entire law unconstitutional because the law couldn’t exist if the “shared responsibility payments” disappeared. Those were extra tax payments people who choose not to have insurance have to pay, instead of being able to take advantage of Obamacare for insurance only if they get sick and need coverage. (Like Medicare — everyone has to contribute or it doesn’t work.) The best analysis says the likelihood of the new ruling being upheld on appeal is slim, but, these days, who can count on that, or on the Supreme Court making the correct decision a second time should it come to that?

Knowing full well the lawsuit was in the works, Republicans running for office in the midterms pretended otherwise, making fools of themselves trying to keep their distance from it. Their oily assurances that, of course, they were going to uphold our protection against predator insurance companies segmenting out sick people who threaten their bottom line was hypocrisy personified. A few were actual attorneys general seeking re-election who had filed the lawsuit and others were from participating states.

Let’s say Obamacare does disappear. What else will that mean? Young people, just getting started on their own, won’t be able to stay with their parents’ insurance plans until they turn 26. Private insurers will lose the financial assistance they receive to help cut their losses for providing expanded services and having to cover sick people, which encourages them to participate in the Obamacare insurance exchanges. Rules that establish a basic minimum of benefits that insurance companies have to cover would be gone, as well as banned coverage limits. The millions of people in 37 states who have been able to be insured through Medicaid expansion would lose their coverage. The millions who have had the advantage of subsidies, based on need, to purchase insurance through Obamacare could be without insurance again. According to the Urban Institute, the uninsured rate would increase by 50 percent and lead to more than 17 million losing their health insurance.

This ruling, should it stand, would inflict severe damage on the American healthcare system. Perhaps that’s why a bipartisan group of nine governors, the American Medical Association, the American Hospital Association, America’s Health Insurance Plans, AARP and other health-related groups strongly opposed the lawsuit. Liberal and conservative legal experts considered the lawsuit frivolous and unsound and were surprised by the ruling. Um, might that decision be what Republicans mean when they rail against “legislating from the Bench“?

Who supported it? Well, Republican officials from Alabama, Wisconsin, West Virginia, Arkansas, Arizona, Georgia, Florida, Texas, South Dakota, Indiana, Kansas, South Carolina, North Dakota, Louisiana, Maine, Nebraska, Missouri, Mississippi, Utah, and, wouldn’t you know, Tennessee. And, of course, the Trump Administration, even though it is the normal practice to defend in court challenges to a federal statute, passed by Congress. Then-Attorney General Jeff Sessions and his department (that’s our Department of Justice) actually argued that the only provisions that the court should strike down are the provisions that protect people with pre-existing conditions. Mull that over for a spell. Trump’s tweets have been euphoric that Obamacare “has been struck down as an unconstitutional disaster!”

Responding to a fool’s errand can feel good and dismaying at the same time. That’s how I feel. May it be as fruitless as the phrase would indicate. Thanks be that Democrats, with far more women serving us, will be addressing this dilemma.

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