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David France’s extraordinary documentary (and book) How to Survive a Plague chronicles the history of ACT UP, the group of HIV+/AIDS-infected gay men who fought to make drugs more affordable to those suffering from a condition the government laughed off as a “gay plague.” In order to spread their message, these men (and women) had to essentially become scientists, memorizing whatever literature on these drugs came out to know a) how the drugs affected them, and b) how to inform others of what they’d do. Knowing that nobody would save them, they saved themselves and millions of others through their protest and self-education.

We have to take a page from their playbook as Senate Majority Leader and Sentient Turtle Mitch McConnell has finally allowed the public to see what’s in the upper chamber’s healthcare bill, called the Better Care Reconciliation Act, or as I call it, BECRA. And to no one’s surprise, it sucks. This bill, drafted by 13 white men, is a toxic waste dump inside of a garbage fire inside of a volcano inside of an abandoned Arby's. 

OK, that last part may have been hyperbole, but if we’re going to fight back against this thing, we’ve got to understand what’s in it. McConnell wants to bring this to a vote before the July recess, so we don’t have a lot of time - and since I wrote this piece on Friday, we have even less time. If you’re one of the 23 million (according to the House bill’s CBO score) who could lose their insurance if this thing passes, and you still want to blow cool from ACA, let’s start answering some questions.

Does this bill run over Obamacare with a steamroller?

Not entirely. According to Politifact, BECRA will still help you find a plan that’s right for you based on income/location, and it would not deny you the right to purchase government-funded healthcare if you have a pre-existing condition.

That doesn’t sound too bad!

Actually, it is. If we know anything about Republicans, they’re really great at making people jump through tons of extra hoops to get what they want. In this case, people who are on Medicaid or already have an existing program will see a drastic reduction in the number of benefits they can have, depending on where they live. BECRA is going to take a wrecking ball to Medicaid by pulling money from it.

Oh no! Am I one of the Americans who would lose my health insurance?

If you’re a low-income person whose insurance is covered by Medicaid, the bill will phase out the funding provided to the states for your insurance, so yes, you could lose it. By 2019, Medicaid would cease to be an open-ended fund. For more information, here’s a tweet from Planned Parenthood’s Cecile Richards:

What does open-ended mean?

Right now, Medicaid funds are allocated to states based on their respective income. So, if a state has a higher per capita income, it gets less Medicaid funding, whereas a poorer state would have more, because under Obamacare, almost everyone is eligible for Medicaid.

How is the funding different under BECRA than under Obamacare?

Under BECRA, Medicaid will only receive per capita funding, meaning every state would get a fixed amount. If that happens, fewer people will be able to afford Medicaid, since the state only gets enough money to insure so many people. Think of it as the difference between income-based taxes and a flat tax — great for the rich, but bad for the poor.

Speaking of taxes, how much would the rich get if this went through?

A lot. Because Obamacare was paid for by levying taxes on the wealthy, BECRA would repeal those taxes so the richest 1% and the insurers would get a financial windfall over the next ten years of $220 billion.

But, assuming that the worst happens, and somehow or other, I get to keep my Medicaid insurance under this new law, I’ll still be able to have the same benefits that I did before. Right?

No, not necessarily. If funds are limited per enrollee, then the state will have to cut many benefits that they would otherwise have the funds to take on, like disaster relief.

Oh no! That’s bad. What happens to Planned Parenthood?

Stays exactly the same.


No, silly! These are Republicans we’re talking about! BECRA would eliminate all Medicaid funding to Planned Parenthood, and since Medicaid accounts for 75% of its funds, many states would be forced to shutter their Planned Parenthood clinics entirely. And even if you’re lucky to have access to Planned Parenthood if the bill passes, then you’d have to pay out of pocket for your visit, since it would no longer be covered by Medicaid.

What would happen if I got an unwanted pregnancy and I wanted an abortion?

Planned Parenthood hasn’t received federal funds for abortion since The Hyde Amendment passed in 1976, so Obamacare covered abortions through a separate, private fund. You could, for example, cover your abortion through your private insurance program, like maybe the one your employer offers you. BECRA would strip away tax credits for programs that cover abortion, so chances are, your employer might not be able to cover it. And, to top it off, employers who cover abortion would be unable to access the $115 billion State Stability and Innovation Program, which provides money to states in order to prevent insurance plans from leaving the market for lower premiums.

OK, so I had my baby and I still have some form of insurance. Does it at least cover maternity?

The ACA was required to cover what are known as the “Essential Health Benefits,” one of which was maternity care (the full list can be accessed here.) BECRA attempts to make these laws optional for certain states, and makes it easier for the states to get a waiver to drop them. For more ways this bill affects women, here’s the full article I’ve included several hyperlinks to, available on Vox.

Enough about women already! I’m a middle-aged dude! I don’t have to deal with all this stuff!

Yeah you do. Check the list of Essential Health Benefits. If you’ve got one, you’re at risk. There’s also the fact that if you’re old, the cost of your premiums will increase the older you get.

Explain how.

Today, insurers can only charge an older person three times as much as a young adult like myself. Thanks to this bill, that would be increased to five times as much, so it’s better for me, but worse for you.

OK, fine. But you’re not at risk, Jeremy! You’re like, the healthiest person ever!

Actually, that last part is true. I have never spent a night in a hospital in my life and have only been to the ER twice: once for an allergic reaction from bad medicine, and once when I had my kidney stone during my first week of grad school at Harvard, and it was covered by Romneycare (thanks, Mittens!) Now I’m covered by Medicaid and New York Healthfirst, who’ve provided easy access to the drugs I’ve need. I’m not employed right now, and once more for those in the bleachers, George Soros is NOT paying me to write this. But even if I were employed, and even if Soros made me a rich man, the insurance provider for whatever company I'm at could still wave their right to cover my drugs. And since I rely on Medicaid to get them at a low price, and to not have to pay for my healthcare, I'm at risk. 

That would suck!

I know it would.

This bill sounds really sucky. Is there anything I can do about it?

Yes! Call your Senators. Here is the script for Republican Senators and the script for Democratic Senators. In the meantime, continue resisting and look at this picture of my cute dog.


Hey, that’s not your dog!

All right, you caught me. It’s my dog’s best friend. This is my dog.


Awww, he’s so cute!

I know, right?