Our decision will tell whether America is still great

Last week I focused on a single individual, artist Nick Serratore, who had benefitted from the Affordable Care Act.

But the ACA's benefits go far beyond helping a small, limited number of our friends and neighbors. It benefits Sussex County's entire healthcare system.

One important piece of that system is the La Red Health Center, which has two locations in Seaford and one each in Georgetown and Milford.

Brian Olson, La Red's CEO, spoke recently at a rally in support of the ACA held at Nanticoke Health Services hospital in Seaford.

La Red's goal, Olson said, has been to "move the pendulum" from sick care to "a system of wellness and preventative care."

Because of the ACA, they've made progress. People who were previously uninsured have been able to get coverage through either the marketplace or the Medicaid expansion.

La Red serves more than 11,000 Sussex County residents. Many of their newer clients, he said, were excluded from the healthcare system because of pre-existing conditions, an issue ended by the ACA.

Others are college students, also new to coverage because the ACA allows parents to keep their children on their health insurance until age 26.

Among those who have been helped, Olson said, was a widow "who was nervous because she had been uninsured for two years. And her only source of income ... was her late husband's Social Security survivor benefits."

Her income, while meager, placed her slightly above the federal poverty line. Without the ACA, she would have been out of luck.

When La Red was able to find a plan she could afford, he said, "she broke out in tears."

Olson also told of a family that included a mother, a father and three small children. Shortly after they were enrolled in a plan, "one of the children was diagnosed with leukemia.

"Fortunately, the child was able to access critical healthcare services and I'm happy to report the child is now in remission," Olson said.
Without the ACA, that diagnosis would have come later, perhaps too late.

Congress and President Trump have taken the first steps toward repealing the ACA.

Neither Congress nor Trump has a replacement, so we have no idea what a new health plan would look like.

Recently, Trump promised "insurance for everybody."

But later that same day, Sean Spicer, Trump's press secretary, said "insurance for everybody" was more of a "figure of speech" than a literal promise.

Good to know.

According to the nonpartisan Congressional Budget Office, 18 million people could lose their health insurance in the first year.

Will that include the widow and the cancer-stricken child mentioned above?

Who knows?

Here's what we do know. If the ACA is repealed it will mean, for the top .01 percent, an average tax cut of $154,000, according to the Tax Policy Center.

The 400 richest Americans, according to Business Insider, will receive, on average, a $7 million tax cut. These are people whose average annual income rises above $300 million. (Yes, $300 million a year.)

According to Olson, congressional actions may already be having an effect.

Because of the uncertainty surrounding the ACA, he said, some clients are considering not paying their health insurance premiums.

Their thinking, apparently, is: If it's going to end soon anyway, why keep paying?

"This is not a viable option," he said. They could have their policies cancelled. "Unfortunately I fear that many of them will end up using emergency departments again, which is totally inappropriate."

That means emergency rooms will be filled with people who shouldn't be there. These are people who would have been treated earlier – when their symptoms were less severe – by centers such as La Red.

That's bad news for the patients as well as the healthcare system. It's a step back toward sick care instead of focusing on wellness.

Last year's dispiriting campaign included a lot of talk about making America great again.

America, of course, was great before Trump decided to run for office, but his slogan begs a question: How do we measure greatness?

With healthcare, we have a stark choice.

We can enrich the already rich.

Or we can extend health insurance to widows struggling to maintain their health and their dignity.

We can guarantee that the descendants of today's billionaires will inherit an even larger bundle of money.

Or we can give a kid a fighting chance against cancer.

It's up to us. What we decide will tell us whether America remains "great."

Don Flood is a retired newspaper editor living in Lewes.