Millions of people heaved a sigh of relief at news that the Republican efforts in the U.S. Senate to repeal and replace the Patient Protection and Affordable Care Act had failed.
But, as Social Service Sr. Simone Campbell, executive director of NETWORK, a national Catholic social justice lobby, pointed out in an email to opponents of the repeal effort, it is not over yet.
First and foremost, Senate Republicans said July 20 they intended to press forward with a vote this week, the week of July 24, on whether to begin debating on health care, the New York Times reported, though they didn't yet know whether they would be voting on their proposal to replace parts of the Affordable Care Act with a bill that would end health insurance for 15 million people next year and 22 million by 2026 or on a full repeal with no replacement, which the nonpartisan Congressional Budget Office estimates would end health insurance for 32 million people by 2026.
It appears that neither effort has enough votes to pass, but again, that doesn't mean the fight is over.
That's because President Donald Trump has said the Affordable Care Act is dying — and he is working to make that statement true.
The New York Times on July 19 reported on three things the Trump administration is already doing to ensure the Affordable Care Act fails, another it is considering and two more it could do.
First, the administration is weakening enforcement of the individual mandate. That's the provision — ironically proposed in the 1990s by the conservative Heritage Foundation but now so hated by Republicans — that requires nearly everyone to have health insurance or pay a tax penalty. Having everyone buy insurance ensures enough healthy people are in the system to make it affordable to cover sick people.
But the IRS under Trump will continue to accept tax returns that do not state whether the filer has been uninsured. It's a little like having a speed limit, but with the police department saying they're getting rid of their radar guns.
Second, the administration is now letting states propose work requirements for Medicaid recipients. Many of the millions of people who gained health insurance under the Affordable Care Act got it through the expansion of Medicaid, which covers poor adults. Now, they could face work requirements or new premiums.
Third, the administration has stopped advertising and outreach to help people sign up for coverage. The Associated Press reported the administration has already ended contracts in 18 cities with groups that informed people about their coverage possibilities and helped them through the complicated process of getting coverage.
But wait, there's more!
They're also proposing to reduce the tax credits that help middle-income people pay for insurance. That means people will have to either pay a bigger share of the cost to keep the same coverage or keep their cost the same by moving to a less-expensive plan — which means less coverage and higher deductibles and co-payments.
There are other things the administration could do, as well. One is to end the subsidies that insurance companies get so they can reduce the cost of insurance for those with lower incomes. That, the New York Times said, would cause premiums to spike, would make insurance companies lose money and would force some into bankruptcy. Another is to change the definitions of essential benefits, which are categories of conditions the Affordable Care Act requires all health insurance policies to cover. Because they are law, the administration cannot change them, but they can change the rules on how they're defined and enforced.
Honoring decades of service
Several times, when our children were younger, they were invited to birthday parties where the host specified: "No gifts." In those cases, we usually took the money we would have spent on a gift and used it to purchase a flock of chickens or ducks in the child's name through the Heifer Project.
The Sisters of Charity of Nazareth, who recently celebrated jubilees, had a similar idea: The 21 sisters commemorating 55 to 75 years in religious life said the best way to honor their service was to give to people who live in poverty, resulting in an $800 donation to the St. Vincent DePaul Outreach Ministries in Bardstown, Kentucky.
Remember, links, tips and accounts of the response to any crisis anywhere in the world are always welcome at firstname.lastname@example.org.
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