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Paying for treatment for chronic conditions

Merakey, formerly known as NHS human services, announced last week that at the end of October it will close most of its facilities in Northeast Pennsylvania, and that will have an impact on clients in Wayne and Pike counties among others. The company says the closures will impact about 2,400 patients and 150 employees.

The Wayne County supervisors responded to the news by putting out a statement assuring the public that patients will continue to receive services, “until all persons currently receiving services are enrolled in a safe program.”

There is no doubt that the supervisors mean well. But a man named Charles Farr issued a post on social media that said, “I have been an employee of Merakey NHS since they took over Tri County in this area. I can assure you that not all will have service by the time October 28th rolls around.” He then listed a couple of doctors at a counseling center in Scranton that have waiting lists over six months long.

Merakey offers services for autism, intellectual and developmental disabilities, addiction and other conditions. The company said the main reason for the scheduled closure is because insurance companies don’t reimburse for services at sustainable levels. A Merakey spokesman, Kevin Feely, said, “Merakey has tried for most of the last decade to find a way to offer these programs as affordably as possible, and it just can’t do it anymore.”

This comes at the same time when the Affordable Care Act remains under assault by Republican lawmakers around the country, and specifically the part of the ACA that guarantees coverage of pre-existing conditions, which includes many of the conditions Meraky offers treatment for.

On September 5, a trial started in a Texas court room, brought by officials in 20 Republican-controlled states, that would remove the protections for pre-existing conditions from the ACA, allowing companies to deny coverage to such clients or increase the price for coverage to unaffordable levels. The trial is supported by the administration of President Donald Trump, which has said it will not defend the ACA in court.

This despite the fact that the pre-existing condition element of the ACA is incredibly popular with the public, as is the community-rating element which, in the words of the federal government, “prevents health insurers from varying premiums within a geographic area based on age, gender, health status, or other factors.”

A tracking poll released by the Kaiser Family Foundation on the same day as the trial in Texas started found that “a majority of the public say it is ‘very important’ that the Affordable Care Act’s protections for people with pre-existing conditions ensuring guaranteed coverage (75%) and community rating (72%) remain law. About half (52%) of the public are ‘very worried’ that they or someone in their family will have to pay more for health insurance and four in ten (41%) are ‘very worried’ they will lose their coverage if the Supreme Court overturns these protections.”

But lawmakers in Washington have shown time and again that the will of the public does not play much of a role in their political calculations, and on the same day that the Texas trial began and the Kaiser poll was published, the confirmation hearing began for Brett Kavanaugh, Trump’s nomination to the U.S. Supreme Court. No matter which way the pre-existing case goes, it will very likely end up in the highest court in the land, and Kavanugh, as expected, has declined to say how he would vote on such a question.

But his previous writings have made it seem like he would be open to striking down the law, or allowing the president to do so unilaterally. In a dissent about the ACA’s individual mandate, which was ultimately removed by Congress, Kavanaugh wrote, “Under the Constitution, the President may decline to enforce a statute that regulates private individuals when the President deems the statute unconstitutional, even if a court has held or would hold the statute constitutional.” Beyond the ACA question, that’s a striking view of presidential power.

In any case, the closing of Merakey makes clear that the treatment of pre-existing conditions such as autism and addiction are not being adequately funded for many people in the country; our system of private insurance is simply not up to the task, and Republicans want to weaken it further. If there is a Democratic blue wave in November, it will have been fueled in part in the Republican attacks on healthcare.


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