House Considers Replacement Health Bill

The Wired Word for the Week of March 12, 2017

In the News

On Monday, some House Republicans unveiled a health-care bill they call the American Health Care Act (AHCA) which they want to pass to repeal and replace the Affordable Care Act (ACA) passed by Democrats in Congress without Republican support in 2010 and signed into law by then president Barack Obama. Now that Republicans have the majority in both the House and the Senate and is the party of the current president, Donald Trump, the bill has a chance of becoming law, either in its present or revised form.

Whereas the ACA has frequently been called "Obamacare," the AHCA is already being called "Trumpcare," although it is missing some of the items Trump requested in his address to a joint session of Congress recently. Nonetheless, he has declared "our wonderful new healthcare plan is out for review and negotiation," indicating his support for it at least as a starting point.

Republicans have opposed the ACA from its inception and have made several efforts to repeal or change it while Obama was in the White House. While in general, Republican philosophy doesn't like federal government support of entitlement programs, some observers have claimed Republicans' opposition to the ACA has been more because it was program of the Democrats. Though invited by Democrats to participate in drawing up the bill that became the ACA, Republican leadership refused.

Politics aside, however, many Americans have a stake in what ultimately comes from Congress on this matter, for about 20 million of us currently benefit in some way from the ACA. Initial analysis of the proposed AHCA, suggests that it would leave more people uninsured than does the ACA. However, the AHCA bill is still in early stages and may be amended, if it passes at all.

There are observers who maintain that the ACA also harms some who get coverage under it, though it is difficult to calculate benefits versus harms. For example, consider a 22-year-old who remains on his parents' insurance plan through age 26 instead of purchasing a less-expensive and ACA-forbidden catastrophic health insurance plan on his own. The parents' insurance premiums go up and the possibly more suitable insurance plan is unavailable. Such a person is counted by the Department of Health and Human Services as one of the 20 million who benefit, yet can possibly be counted as a person harmed.

Some say the AHCA as currently proposed would have similar shortcomings. The House Freedom Caucus, which includes many veterans of the Tea Party movement, and some Senate allies, have dubbed the AHCA as "Obamacare Lite."

It should be noted that "health insurance" is not "health care" -- and, in fact, most current health "insurance" policies mainly are funding-stream mechanisms with only a small insurance component. Nonetheless, as medical services and costs are structured in the United States today, not many people could afford adequate health care throughout their lifetime without some form of health insurance, whether that comes from private pay, as a benefit of employment or from a government program.

More on this story can be found at these links:

House Republicans Release Long-Awaited Obamacare Replacement Bill. Fox News 
Republicans' Obamacare Replacement Bill: The Winners and Losers. CNN MoneyRepublicans' Health Care Bill Unlikely to Quell National Debate. TIME

Applying the News Story

At issue with both the ACA and AHCA is this: Should all Americans have access to affordable health care and should the federal government be involved in providing that?

The Big Questions

1. As a Christian, are there any reasons you would not want every American to have equal access to health care? If so, what are they? In terms of what's possible, is "equal access to health care" actually a thing that can exist or even be approached in a free society? Explain your answer. What do you think Jesus would say about this matter?

2. While "the devil is in the details" of whichever plan addresses this matter, do you agree that in principle, universal affordable health care is a moral issue? Why or why not? What is actually meant by each of the words, "universal," "affordable" and "health care"? Is there any way this goal can be approached without government involvement, and if so, what way?

3. What meaning did Jesus' healing ministry have for his overall mission? What do you make of the fact that in Nazareth, Jesus was able to perform only a few healings because of unbelief among the local people (Matthew 13:58)?

4. Is Christianity as much concerned with the well-being of our bodies as with the well-being of our souls? Explain your answer.

5. Political territorialism aside, what values should national legislation reflect when it comes to health care? Or should the government keep out of it, and if so, would the viable alternatives instead see that no one was financially shut out of adequate health care?

Confronting the News With Scripture and HopeHere are some Bible verses to guide your discussion:

1 Samuel 2:8He raises up the poor from the dust; he lifts the needy from the ash heap, to make them sit with princes and inherit a seat of honor. (For context, read 2:1-10.)

This sentence is from the prayer of Hannah, the mother of Samuel. She had been childless, but God answered her prayer about that, and she eventually bore a son. In gratitude, Hannah brought Samuel, as a young child, to the worship center at Shiloh to serve the Lord there under the tutelage of the high priest Eli (all of this is recorded in chapter 1 of 1 Samuel). Her prayer follows the presentation of her son to Eli.

The words of Hannah's prayer do not refer specifically to her situation, but are more in general praise of God. And one of the things she notes about God is his care for the needy, mentioned in the verse above.

In the Bible, God's concern for the poor and needy is not a side issue; it is a major theme of scripture, in both the Old and New Testaments.

Questions: Given that people with low incomes often have difficulty affording both health insurance and medical care, how does this verse apply to your view of health-care legislation? How does it apply to your own responsibility for the health care of others? How do some people use "the government's responsibility" to avoid their own responsibility?

1 Samuel 30:24… For the share of the one who goes down into the battle shall be the same as the share of the one who stays by the baggage; they shall share alike. (For context, read 30:1-25.)

The story in 1 Samuel 30 comes from the period when David, who later became king of Israel, was in fact an outlaw in Israel.

He didn't intend to be. In fact, he had served Israel's king, Saul. But as David was successful in that position, Saul became jealous of David's reputation and sought to kill him. David was forced to flee for his life from Israel, and eventually, some 600 men joined him, forming a kind of private police force.

David, his men and their families settled in Ziklag, a town under Philistine control. From there, they raided some non-Israelite villages belonging to other enemies of the Philistines.

Eventually, while David's men were out of town, some Amalekite raiders overran Ziklag, plundering the goods, burning the buildings and capturing the women and children. When David and his men returned and discovered what had happened, they were already weary from three days of travel, but nonetheless set out in pursuit of the Amalekites. By the time they came to the stream called the Wadi Besor, 200 of the men were so exhausted they could not continue, so David allowed them to remain there. The remaining 400 went on without them. This reduced group caught up to the Amalekites and killed them. They freed their families, reclaimed their goods, and took the goods, flocks and herds of the Amalekites as spoils of war.

Returning, David and the 400 came upon the 200 men who had been left behind. As the latter came out to cheer their victorious compatriots, some of the "corrupt and worthless fellows" (v. 22) among the 400 said that the 200 should not receive a share of the spoils because they did not participate in the fighting. They were willing for the 200 to reclaim their wives and children, but didn't want them to receive any of the wealth that had been seized from the Amalekites.

David, however, would have none of it, and made the statement in the verse above about all sharing alike. By so doing David reinforced the sense of cohesion among his men and showed that he understood some of what it takes to make a mob of individuals into a fighting force. From a military standpoint, David's decision acknowledges that those in reserve, who guard the supplies, or who are recuperating also contribute to the military action. This is reflected in the adage coined by the poet John Milton: "They also serve who only stand and wait."

Given the political environment of health-insurance legislation, it's worth noting that there were political overtones to David's share-and-share-alike ruling. His action was generous, but it also helped to build a broad base of support for him so that later, when the throne of Israel became vacant, David was the man the common people want to put there.

Questions: If you were among the 400 who did the fighting, how would you feel about sharing the spoils of your battle with the 200 who couldn't keep up? Would there be some resentment there? While the spoils of war are fungible and not the in same category as health care, which is not fungible, should the "share-and-share-alike" principle apply to health care? to health insurance? Why or why not?

Luke 10:8-9
Whenever you enter a town and its people welcome you, eat what is set before you; cure the sick who are there, and say to them, "The kingdom of God has come near to you." (For context, read 10:1-12.)

These words from Jesus were part of his instructions to the 70 people he sent out on a mission throughout Palestine. Note that Jesus told them to not only proclaim the news that the kingdom of God has come near, but also to cure the sick. And he never says to the 70 that the proclamation is more important than the curing. In another place, Luke records that people came to Jesus both to "hear him" and to be "healed of their diseases" (Luke 6:18).

Both of these examples are from Luke, but all four gospel writers report Jesus' healing ministry. While Jesus may not have considered those first-century healings as his main ministry, he clearly considered them as part of his work and integral to his whole mission.

TWW team member Liz Antonson, who worked for more than 30 years in a health-care system points out that until recent times, hospitals were the product of religious charity. Several Christian denominations created and ran hospitals. But she says that in her lifetime, that has changed. Hospitals with names like St. Luke's and St. Elizabeth's are no longer religious institutions, except in name only. Antonson adds, "The demise of charity care to the poor and nearly poor and the not poor in our country has been directly due to the construct of commercial government insurance.

"Charity organizations have turned to commercial and government insurances for reimbursement," she says, "and the ministry of providing for the sick and dying is gutted."

Questions: Does Jesus' emphasis on healing suggest how he might view health-care legislation? If so, what does it suggest? Is Antonson's view correct that insurance has caused the demise of charity care? Would charity care be sufficient today, given the size of the population?

Matthew 7:12In everything do to others as you would have them do to you; for this is the law and the prophets.(No context needed.)

You no doubt recognize this as the "Golden Rule." It is included in Jesus' Sermon on the Mount, and, it seems to us, has a straightforward application to the universal health-care debate: I want adequate and affordable health care for myself, so, in line with Jesus' teaching, I want the same for others as well.

Questions: Is universal affordable health care a "love your neighbor" issue? Is it a matter of general ethics? Both? Neither? Should there be exceptions? Explain your answer. Are wanting it for all and who should pay for it two separate issues? Why or why not?

Luke 10:34-35He went to him and bandaged his wounds, having poured oil and wine on them. Then he put him on his own animal, brought him to an inn, and took care of him. The next day he took out two denarii, gave them to the innkeeper, and said, "Take care of him; and when I come back, I will repay you whatever more you spend." (For context, read 10:25-37.)

This is from the well-known parable of the Good Samaritan. A man on a journey was beset by robbers, who beat him and left him by the roadside. Two men, a church ruler and a church worker (to use modern terms) passed by, electing not to help the victim -- nor, in today's context, seeking to get the church or government involved. An outcast, however, did help the victim. He used his own possessions -- medicine, transportation, lodging payment -- to help. He took charitable responsibility to be "a neighbor" to the victim.

Questions: Does this model of personal charity -- to be a neighbor to those who need medical care -- work in our society today? If so, who might be left out? If not, why not?

For Further Discussion

1. If you, or someone you know, has benefited from the ACA, consider sharing that story. If you, or someone you know, has been negatively impacted because of the requirements of the ACA, consider sharing that story.

2. Back in 2009, when the ACA was being worked on, an editorial in The New Republic said, "One reason we're talking about reform today is that our system forces Americans to pay too much for what are, frequently, substandard results. But another, perhaps more important reason is that our system leaves a large number of Americans, including many members of the middle class, profoundly vulnerable to the effects of illness. People losing their life savings or their homes because of their medical bills, people skipping necessary care because they can't afford it -- these things should not happen in a responsible, modern society. We can't stop people from getting sick, but we can stop sickness from ruining people's lives -- or taking their lives away altogether." How might this be addressed by the new proposed bill?

3. There are Christians who believe that health care would be significantly better, less expensive, and more available were government to be much less involved with financial and other controls. Some argue that health-care decisions and payments are personal responsibilities, and that those who truly cannot afford health care should be helped by charitable organizations, including churches, not by government. Discuss why this is or is not adequate.

Responding to the News

Some of the material and biblical texts from this installment of The Wired Word could be used as the basis of a parish-wide discussion that goes beyond the class or small group.

This is also a good time to speak as a church to your legislators about this legislation.

Prayer

O God, who calls us to love our neighbor as ourselves, help us grasp the size of the "neighborhood" you have in mind and then, in your name, to do our best. Through Jesus we pray. Amen.