Opinion: The Hidden Horrors of Healthcare Reform

Oct 24, 2017

Credit Abraham Schwab

The “self-fulfilling prophecy” was a term first coined by Robert Merton: “a false definition of the situation evoking a new behavior which makes the originally false conception come true." In my view, this term is perhaps overused. But in the case of the efforts of Donald Trump’s administration and the GOP members of Congress, well, if the shoe fits . . . 

For the duration of Trump’s administration and before, there has been statement after statement after statement about how Obamacare is failing. This, in spite of the piles and piles of evidence that it is (or was) generally working. It’s not without its problems, as I’ve mentioned before. But it is (or was) generally working. 

Enter the Trump administration’s approach to Obamacare. They began by shortening the enrollment period for the Exchanges. They also cut the funding for the advertising of the enrollment period. Then they cut the payments to groups who help people sign up. And now the Trump administration has cut the cost-sharing subsidies that made insurance policies available through the Exchanges affordable for low-income individuals. Of course, this last cut was only made possible by a legal challenge to those subsidies brought by House Republicans. 

The motivations for these decisions by the Trump administration and this legal challenge by House Republicans are clear: to undo Obamacare. The outcomes are also clear: fewer people will have health insurance. And when people lack health insurance, they are more likely to die. 

I’m reminded of the story of Monique A. “Nikki” White that T.R. Reid tells in his 2010 book The Healing of America. After she was diagnosed with systemic lupus erythematosus, Nikki was unable to get insurance coverage and couldn’t afford to pay for the needed medical care out-of-pocket. Systemic lupus erythematosus is a manageable disease, but only with appropriate medical care; Nikki White’s death was a result of a failure, not of our health care system, but of our health insurance system. Removing the subsidies for low-income individuals and families will make insurance unaffordable for some. If these individuals then get diagnosed with a disease like systemic lupus erythematosus, they will be in the same position Nikki White was, needing medical care they can’t afford.

Nikki White’s death didn’t make headlines. Neither will the death of people who cannot afford insurance without subsidies. These are the hidden horrors of the current push for health reform. We do not feel Nikki White’s death. We will not feel the death of any of the nameless and faceless millions who will find insurance unaffordable without these subsidies. 

It’s possible that Congress will pass the bill that Senators Lamar Alexander and Patty Murray have put together to extend the subsidies for two more years. But why stop paying the subsidies in the first place? Why hinge the lives of low-income individuals on whether such a bill passes? We can only assume it’s because the Trump administration doesn’t care if low-income individuals die. 

And any members of the House and the Senate who haven’t pushed back on the Trump Administration’s decision (including Indiana’s own Jim Banks, who's in favor of cutting the subsidies, and Todd Young, who has yet to comment on it) are telling us the same thing. I wouldn’t venture to guess what it is that they do care about, but it’s clear they don’t care about the deaths of low-income Hoosiers and other Americans. 

Abraham Schwab is a Fort Wayne associate professor of philosophy and medical ethicist.

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