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GOP undermines ACA and escalates American anxiety

December 20, 2018

“How many times do we have to go through this?”

That’s what Kathy Tomasic wants to know. Painstakingly, she has planned her life — and that of her teenage son, who has a rare genetic disorder — around access to health care. She did so based on a specific set of assumptions about what kinds of insurance would be available to her family, under what conditions and for how many years.

But Friday, that careful planning was once again thrown into doubt — this time by a federal judge’s decision in Texas declaring the entire Affordable Care Act unconstitutional.

In public remarks, Republicans have tried to reassure the public by saying, “Nothing changes tomorrow.” This case may or may not make its way up to the Supreme Court, they note; the high court may or may not reverse the ruling; and Congress may or may not pass new legislation ultimately preserving the many popular provisions of Obamacare, which, by the way, turn out to be almost every major provision of Obamacare.

In other words: Don’t worry! It could well be years before this latest threat to the law you depend on does damage! Coming from Republicans, this is truly a bizarre message.

For a decade, they decried the intolerable “uncertainty” that Obama-era policies created for businesses. How could entrepreneurs decide how much to invest, and where, and under what terms, they asked, if the rules of the road were in flux?

Yet Republicans’ relentless attempts to undermine the ACA — through repeal, arbitrary regulatory changes and delays, funding cuts, elimination of low-income subsidies, a never-ending parade of lawsuits — only escalate this anxiety-inducing uncertainty.

Not just for businesses, but for millions of American families, too.

I first spoke to Tomasic last year, when Congress was trying to repeal the Affordable Care Act legislatively. Like others among the 60 percent of Americans whose households include someone with a pre-existing condition, she found this prospect terrifying.

Her younger son, Alec, is something of a prodigy. At 15, he was accepted to the University of California at Berkeley, where he’s now a junior studying physics. He hopes to enroll in a Ph.D. program when he graduates, likely focusing on fusion research.

But arranging these educational feats has been complicated. Alec has a disorder called mastocytosis, which periodically sends his body into shock and lands him in the hospital.

For years, Alec’s older brother, Nelson, helped care for him. When Alec was accepted to Berkeley, though, his mother decided it was time to let Nelson live his own life. She quit her full-time job in San Diego and moved with Alec to Berkeley, which gave her a flexible, part-time position.

Depending on her hours, however, that position doesn’t reliably come with benefits. She decided to make the career move anyway because she knew she could purchase subsidized Obamacare insurance, which next year will cost her about $400 per month.

When Congress tried to repeal Obamacare last year, she fretted. At 59, she says her own health is “not pristine”; she’s not sure she could find a new job that offers insurance; and without coverage herself, what would happen to her sons if she falls ill or dies?

So when repeal failed, Tomasic breathed a huge sigh of relief. Then came this latest lawsuit from the attorneys general and governors of 20 red states.

Using a legal argument that’s been deemed ridiculous by even conservative legal scholars, these states persuaded a Texas judge to strike down the individual mandate, and with it, the entire ACA — its protections for those with pre-existing conditions, its Medicaid expansion, its income-based subsidies, everything.

Given her age and health status, Tomasic’s ability to buy insurance on the individual market could disappear if the ruling stands. She’s not the only member of her household at risk of losing insurance either. Alec gets coverage through his father’s plan, which the ACA allows him to remain on until age 26; if the law goes away, that plan could boot him as early as age 19, depending on his school status.

Perhaps he could then enroll in a plan through school. But not all such plans cover the $2,000 shot he gets each month to stabilize his condition.

“All this planning and scheming we have to do, it’s really appalling,” Tomasic says. “Especially in a country as rich as ours.”

Her family’s health and financial security was sewn together with a few fragile threads. Republicans threaten to unravel all of them.

crampell@washpost.com

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