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If you start to read the tea leaves, particularly the tea leaves Justice Ruth Ginsburg dropped last night, I'm thinking SCOTUS is going to eviscerate if not destroy outright the ACA.

“It is likely that the sharp disagreement rate will go up next week and the week after,” she said.
It strikes me we could be on the verge of another bitter life-changing 5-4 decision. If indeed, Justice Ginsburg dropped a hint, and this is what we're facing, the consequences for tens of millions of Americans are simply unfathomable. A 5-4  decision overturning or eviscerating the ACA (despite its terrible inadequacy), is tantamount to a death sentence for countless Americans.

Chaos will ensue.

Next up is Ms. Wilkins, a single mother of three who is seeing you for her diabetes and congestive heart failure. She is fortunate enough to be among the 50,000 Americans enrolled in the low-cost Pre-existing Condition Insurance Plan created by the Affordable Care Act and administered by the state. Oh wait, that was until the Supreme Court decision. With the ACA gone, the authority and funding for the Pre-existing Condition Insurance Plan disappears. Will she still be covered for this visit and any tests or medications she needs? And if so, for how long before the program is forced to shut down? Where else will she find affordable insurance? Will she go without it? Who knows?

A text message comes into you from your 22 year old son, a recent college graduate who hasn’t found a job. He has a doctor’s appointment for the knee he hurt playing rugby, and wants to know if he still will be covered by your health insurance plan. But the requirement that young adults up to age 26 be covered by their parents’ plans was part of the ACA, so presumably, your health plan no longer is obligated to keep him. Will it drop him? If it keeps him on, for how long, and for what extra premium?

 . . .Your hospital expanded its internal medicine residency program because of a provision in the ACA that redistributes unused residency slots in other specialties to primary care. Who will pay for them if Medicare can’t? Will the slots have to be eliminated?

I could write pages and pages more of programs created by the ACA that would be invalidated if the Supreme Court overturns the whole law. What I can’t tell you—what no one can tell you—is how the federal government will deal with the absolute chaos that will follow.

Already,  even before the law has been fully implemented, The Kaiser Family Foundation has released a new survey of insurance brokers.  Brokers see a landscape of hurt.  Americans are facing sharply rising premiums, deductibles and co-pays--in a word, our out-of-pocket healthcare costs are continuing to soar.   This could not be worse news, especially in a climate of economic weakness, high unemployment, and the erosion of healthcare coverage offered even by large employers.
The survey finds that many agents are seeing steep increases in premiums and deductibles for individuals and small businesses purchasing health insurance. When asked to estimate what they expect to be the typical premium increase in 2012 based on what they have heard from insurers, four in ten agents (39 percent) say they expect premiums to increase between 11% and 20% and another third (33 percent) expect them to increase between 6% and 10%. Deductibles are also increasing: about half of agents (51 percent) report that currently, the most common deductible amount for single coverage plans is $2,000 or more, compared to one in five who say deductibles were in this range two years ago.
It gets worse.

A just-released survey by America's Health Insurance Plans (AHIP) shows an explosion in the number of Americans covered by high-deductible health insurance. Nationally, the number grew from 1 million in March 2005 to 13.5 million in January 2012.

The truth is, when you have high deductible junk insurance, you cannot afford to go to the doctor, so you have what we call, 'insurance in name only'.

Juxtapose all this to the news that the  wealth of the American people has been obliterated. All this is clearly unsustainable.

More nightmares . . .

Imagine, you're one of the 60 million uninsured. Maybe you lost your job and could not afford COBRA. Maybe, you've tried to get insurance, but have been turned down because you have a pre-existing condition.

Speaking of the dreaded pre-exisiting condition.  Would you like to know what the rest of the industrialized world thinks of our for-profit insurance system, where except in one of six guaranteed issue, community rating states,  only healthy people are allowed to buy insurance? The rest of the industrialized world regards healthcare as a right, and believes the government has the responsibility to be certain insurance (and healthcare) is available to everyone--as a right of citizenship.  But not in this benighted country.

You've lost your job, you're uninsured. Then, with the passage of the ACA, the government threw you a lifeline--the high risk pool--albeit an expensive lifeline, but a lifeline nonetheless. So if you had some spare bucks (because again in the U.S., we ration healthcare  based on the ability to pay for it), you could finally get coverage.

So you get the coverage, and you finally get some long-deferred healthcare. And  then you find out, you have cancer. And you begin treatment, and surgery is scheduled, much like what MassHarry is describing.  But MassHarry has insurance, despite his serious medical problem, he's one of the lucky ones. What happens to the guy who has the ACA high risk pool, will it vanish the day after SCOTUS does its likely dastardly work?

No one knows. Some bad uncertainly looms for all of us, especially sick Americans in the midst of treatment.

Now for those of you who think, not a chance that SCOTUS will pull the rug out from under the for-profit insurance industry. That the industry wants this "reform" and the 30 million taxpayer subsidized 'lives' (insurance-speak for people covered), to move ahead exactly as planned.  There's new information that AHIP funneled 100 million dollars to the Chamber of Commerce, so it could publically give tepid support for the legislation, while working feverishly behind the scenes to kill it.

Just as an aside.  I am having difficulty finding appropriate language to convey the disgust and despair I feel for this country, this government. I fear even worse hardship and dislocation than we're already experiencing is imminent.  I'm awaiting a deluge of horror stories in my kosmail inbox, and invite you to speak up, so we can leave a written record of these ghastly years for historians.  

I renew the call. The American people must strip health care from all the members of Congress, the United States Senate, the Supreme Court, all those responsible for this unspeakable catastrophe. Is it asking too much for all of them to be required to purchase for-profit insurance in the individual market until and unless the American people have what they so happily accept for themselves and their families.

To those Americans who suffer in pain, who are sick, and who have the misfortune to be citizens of the wealthiest country on the planet, and the one industrialized country where healthcare remains a privilege--I still believe someday healthcare will be a right, but this evening that day seems as distant as ever.

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