In their first attempt to repeal and replace the Affordable Care Act, Senate Republicans sought to gut the Medicaid program by cutting $700 billion in federal funding. Having failed to garner enough votes to pass the Better Care Reconciliation Act, as well as a straight repeal of the ACA, Senate Republicans are now looking to win over the necessary 50 senators to pass a “skinny repeal,” which would essentially do away the ACA’s individual mandate. Surprisingly, such a bill would hit middle- and upper-income Americans hardest and leave the Medicaid expansion virtually untouched. However, since there is no real bill as yet, we do not yet know the final targets of the Senate’s ever-changing “health care” bill. In light of the Senate lack of commitment to any real health care policy or principle, we think it’s worthwhile to repost these pieces we’ve previously published that catalogue the disastrous consequences of the GOP’s various plans to repeal and replace Obamacare.  – Danielle Bizzarro, Executive Editor

***

My lovely friend Abigail* collapsed on her living room floor at age 50 and died days later. She was about seven years out from a breast cancer diagnosis. She had cancer, again, when she collapsed but she didn’t know it.

I can’t think of anyone to whom the words “positive attitude” apply more than they did to Abby. I met her in 2008, in a breast-cancer-treatment support group, and I could hardly get a complaint or doubt expressed without her adding a feel-good coda. “I’m so exhausted,” I might say, to which she’d reply, “When you’re rested, everything’s gonna look so much better!”

This could have felt dismissive but from Abby it didn’t. She wanted everyone to believe that cancer and cancer treatment would simply be portals to an even better life than they’d had before.

This is a story about what happens when people do or do not have adequate coverage for health care.

In the wake of the 2008 recession, Abby lost her job. She made it clear that this was, of course, for the best. She wanted to change direction, get involved with health-related not-for-profits and ultimately work at one full-time. She began working part-time with one such group and volunteering with another. Her income was greatly diminished but Abby was sure that a full-time job would be hers before too long.

This was in 2009 or so. The ACA didn’t exist yet. Abby paid for COBRA coverage, which drained a lot of her savings until it finally ran out. After that, she had nothing. She might have had options; her lower income could have qualified her for financial help. But she didn’t want to look in that direction. She wanted a job with benefits. She wanted an income on which she could live. These would come soon, she was certain. In the meantime, her health coverage lapsed.

Here’s where things get murky for me. I was no longer attending the support group, and I spoke to Abby only every few weeks at that point. When we did speak, she wasn’t one to go into detail on difficult topics — though she did talk about her job search and the promising leads she had.

Other friends of hers, with whom I’ve discussed this, have equally scant information about how she was actually feeling at that time.

Abby told me she was not seeing any doctors regularly because she couldn’t afford to do so. This I am sure of. And then, she started falling.

She joked that she was getting old, and she labeled herself a klutz. The first time she fell, I bought this explanation. The second time, I grew concerned and wondered what to do. The third time, she fell while alone in her apartment, and she never got back up.

I’m not sure if she was unconscious or unable to reach a phone. I’m not sure how long she was on the floor. But her family couldn’t reach her, so eventually a relative showed up at her door with the police. They got her to the hospital, where she died a few days later. I did not know that she’d collapsed until I saw a Facebook post saying “RIP.”

During that final hospitalization, a procedure revealed that Abby had cancerous tumors. But no autopsy was performed, so it’s not known what type of cancer ultimately caused her death.

The first time Abby faced cancer, she had good insurance coverage. She was able to treat the disease and go on with her life.

It’s possible that the original breast cancer had recurred elsewhere in her body. Or it might have been a new cancer, unrelated to breast cancer. It might even have been a new, second instance of breast cancer that spread because it went undetected and untreated.

The second time, she did not have insurance. ACA coverage was not yet available. Abby did not go to the doctor about her increasingly worrisome symptoms. She did not get treatment or even a diagnosis. And she died without even knowing what exactly was making her ill. Abby had been planning, of course, to get her symptoms checked as soon as she had insurance again.

This is what we can expect to see much more of if the Affordable Care Act is attacked rather than strengthened and the latest version of the GOP’s American Health Care Act is passed by Congress.

I have thought so much about what her mind-set must have been in the months before her death—my resolutely positive and cheerful friend who so wanted to believe that great things were just around the corner. “I wondered if she was afraid,” another friend of Abby’s said to me recently. “And her fears may certainly have been compounded by her financial situation. Not only would she have feared what might be happening, she would have feared how she would pay for it.”

This is what the lack of affordable, accessible care for all looks like. These are the terrible losses that result.

From what we know of the GOP’s latest version of the bill, it severely reduces affordable coverage, especially for the sick, the poor, the elderly and the disabled; and it would make it possible for insurance companies to charge consumers pay more for preexisting conditions — especially in a case like Abby’s, in which prior coverage has lapsed.

A study published on April 25 in the medical journal “Cancer” shows that women with no health insurance are 2.64 times more likely to be diagnosed with late-stage breast cancer and 1.61 times more likely to die of breast cancer than women with private insurance.

As cheerful and positive as Abby was, she could not beat a health care system that, prior to the ACA, was designed to protect corporate profits, not patients.

I am sickened by the way my friend died and by all the deaths like hers that might have been avoided with proper care; and I am furious with a Republican administration and Congress that, once again, values corporate profits over human life. We all should be. And we, as a country, must demand better.

-Pamela Rafalow Grossman


*Name and some details changed to preserve patient privacy.

Thank you to Dr. Christopher Li, an epidemiologist and breast cancer researcher at the Fred Hutchinson Cancer Research Center, and Joy Simha, a cancer-research advocate, for their assistance.

 

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