The biggest bioethics story this month was, of course, the “death spiral” of the repeal and replacement of the Affordable Care Act (ACA), known as “Obamacare”.
The proposed replacement law, unveiled as the American Health Care Act (AHCA), was a “Kill Bill” in every way. Under the new law, it was estimated that 24 million Americans who currently have health insurance and access to healthcare, would have lost their coverage. As proposed, the AHCA would have removed the current requirement under the ACA of that mandated coverage for “essential health benefits” comprising 10 services: outpatient care, emergency room visits, hospitalization, maternity and newborn care, mental health and addiction treatment, prescription drugs, rehabilitative services, lab services, preventive care and pediatric services. Republicans argued that such coverage leads to higher insurance premiums. (See: http://www.vox.com/2017/3/23/15031322/the-fight-over-essential-health-benefits-explained).
Basically, the AHCA, which was being dubbed “Trumpcare” would have removed the requirement to cover what most would define as “healthcare”. Some columnists referred to the proposed bill as “cruel” (See: http://www.gq.com/story/trumpcare-exposed-gop-cruelty). Ultimately, once coverage of pre-existing conditions is removed, people die. (See: http://www.npr.org/sections/health-shots/2017/03/23/521220359/gop-health-bill-changes-could-kill-protections-for-people-with-preexisting-condi?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20170323)
But there were many other problems with the bill that would have removed healthcare access, which included restructuring Medicaid, tax cuts, and eliminating the lubricant that allows the ACA to work in the first place: the individual mandate. (See: https://www.washingtonpost.com/blogs/post-partisan/wp/2017/03/24/your-guide-to-the-most-contentious-parts-of-the-gop-health-care-plan/?tid=a_inl&utm_term=.0d36a1dbe10f).
Ultimately, between thousands of protesters voicing opposition to the replacement bill and polling that demonstrated only 17% of Americans were in favor of the proposed replacement bill, the GOP killed the bill, preserving (for now) the ACA. Here are two postmortems from the New York Times:
But the ACA is not “saved”; it remains at risk of being underfunded or sabotaged (See: https://www.washingtonpost.com/opinions/the-real-way-republicans-can-deal-with-obamacare-actually-fix-it/2017/03/24/cef5eba6-10c8-11e7-9b0d-d27c98455440_story.html?hpid=hp_no-name_opinion-card-d%3Ahomepage%2Fstory&utm_term=.eb1a99cec9f0) and http://www.politico.com/magazine/story/2017/03/will-obamacare-really-explode-214949 )
As we ended the month, there were rumblings that there may be another attempt at crafting a Republican healthcare bill, which could be “Kill Bill Volume 2.” (And that may make some heads spin).