March Madness – TrumpCare

I’m not following March Madness this year for the first time since we bought a TV in 1985. We ended cable this year (that’s another health story for later). Rather, I followed the suspense of the failed enactment of RyanCare and TrumpCare. I silently cheered at my seat in DC while reviewing PCORI Palliative Care funding requests.  My elation lasted all of five seconds. I can’t ignore that Ryan, Trump et al still want to end funding for Meals on Wheels, housing subsidies, and home energy supports. We know that even with the best-subsidized insurance, a person who can’t get enough food to eat nor heat their home, nor afford a home can’t benefit from great medical care. These social determinants of health (or living life if you’re not a researcher or policy maker) impact health as much as, if not more than, medical care.

Meals on Wheels serves 6.4 million people each year costing about $2,500 per year per person. Federal sources cover about 30% of that cost. Evidence shows that programs like Meals on Wheels improves the quality of diet, increases nutritional intake, reduces food insecurity, and decreases loneliness – person-centered outcomes all.

2.2 million households use federal Housing Choice Vouchers (88% of whom include children or people who are elderly or disabled). Property owners receive $16.7 million of assistance payment.

$3.09 billion is allocated for the Low Income Home Energy Assistance Program for 2017 (it’s been cut every year). 45.3 million households were eligible in 2013 (9 million households received benefits).

For a perspective, Mr. Trump and family’s travel and protection outside of the White House costs approximately $526 million per year. Members of Congress and their staff receive health insurance through ACA exchanges subsidized 72% by their employer (the federal government). If ACA is repealed, they will revert to previous Federal Employees Health Benefits Program, or FEHBP. Earning on average about $174K per year, their subsidies are approximately $10K per year for families and $5K for individuals. Under TrumpCare persons 60 years old earning $40k per year would have gotten $4k in subsidies.

Does this make sense? What are Trump and Congress entitled to? Where does empathy lie? Who lobbies for the poor? Winning the battle doesn’t win the war. Onward!

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