The ACA repeal, at least until September, is dead. A great many of us celebrate. A great many of us continue to stoke the embers, urging for something more extreme, repeals with no replacement, reducing Medicaid, or those pushing for a single-payer system, or Medicare-for-all. I think NC Senator Jeff Jackson summed it up best in saying that the debate isn’t over health insurance- no one argues health insurance is bad; the debate is over who can and will pay for it.

We all make less than ideal, pragmatic decisions; we buy used tires if we can’t afford new ones. But we’re not arguing whether or not we need tires- we’re arguing who deserves new tires and who has to accept the used ones, or none. Have you ever bought used tires? If you have, I don’t need to tell you that you know they’re going to fail. All you’re doing is praying they don’t blow out before the next payday. And I think that’s a good analogy for the “Skinny repeal” a bunch of other proposals. They weren’t solutions, just patches ’til pay [election] day.

I’m a cancer survivor and a small business owner in NC and I buy my health insurance through the ACA. I’ve seen my premiums go up and my coverage go down under the ACA. But I also remember what it was like to be denied, or quoted $5k+ a month. I also understand that the real reason why my premiums are so high, as are premiums in most southern and midwestern states is that like North Carolina, they refused the federal Medicaid expansion. That expansion was 100% federally funded for the first three years, and no less than 90% funded thereafter. The states that refused did so, on the surface, because they didn’t want to come up with the 10% differential later. But they also politically or racially pledged to undermine anything good that happened under Obama’s administration.

We’re not even talking about the same things. Who’s heard the “get a job, and get one with benefits” line? What about “entitlements” for lazy people who don’t work? The Medicaid expansion package allowed people who effectively make UP TO 138% of poverty line AND meet the other criteria to be eligible for Medicaid. It is impossible to make 138% of poverty line and NOT work so we’re not talking about able-bodied people who just don’t want to work, no matter how badly some want to make it look that way.

Here are some facts-

· Children account for the greatest population of Medicaid recipients (43% in 2015).

· 100% of orphan and foster children are covered by Medicaid

· Childless adults over 21 who are not disabled are ineligible, regardless of income level

· You must be elderly, pregnant, disabled or have small children AND make less than 138% of the poverty level to be eligible

· LEGAL immigrants are eligible if they meet all criteria only AFTER 5 years of legal residence.

So unless we’re suggesting children should find work with employer-paid benefits, or that disabled people “get a job”, we’re not even talking about the same people, much less having the right conversation. Medicaid literally protects the most vulnerable segments of the population.

Like a lot of folks, I’ve spent the last several months calling, faxing and emailing my representatives. I’ve gone from eloquently laid out arguments about how healthy people are working people so if we want people to work, we have to help them get access to health care and then they pay into the tax base. My arguments have broken down over time to essentially begging my senators not to let 23 million people die, and we’re still not having the right or honest conversations.

The last several months can be summarized in one sentence: access to healthcare is a human right OR “sure, we need health insurance, but I’m not paying for other people’s (especially if they got it when a black man was president).” That’s all this is.

So now, I have a few questions:

1. Who do you think you should pay for health insurance?

2. How much does it really cost you to pay in?

3. What happens if people don’t have access to health care and are those consequences acceptable?

Everyone should pay for it himself, seems to be the answer. Does everyone pay for Defense or Education themselves? Or do we for the most part receive those services through the federal and state governments? Might there be some efficiencies to be gained in collective bargaining and risk share? Exactly how much money is the guy making $80k paying for the disabled man down the street to have insurance? Is it $2 a month? $20? Is that an acceptable price to not find him dead in the street or homeless over an ER visit? What does Medicaid cost each of us, by federal tax bracket, compared again to education, or defense or infrastructure? Those are the conversations we need to have and yet it’s a black hole of misinformation and disingenuousness.

Instead of having those conversations, we have a president threatening certain members of our military with expulsion based on their genitalia and how icky it might make others feel if that doesn’t align with their own concepts. In other words, more political decisions based on pee pee. Once banned and dis?/honorably discharged, transgender veterans will become that many more non-working people who will be in need of health insurance and maybe unemployment benefits, too.

Instead we have senators speaking to and voting to debate a bill no one has seen. Instead we have a president threatening senators who oppose repeal, ranting on twitter, and reportedly, via the Department of the Interior, threatening funding for infrastructure projects in a senator’s home state for not toeing the party line. Instead we’ll have Reps like Mark Meadows carrying on about repeal to the death not because he thinks no one needs health insurance, but for politics only.

I want our leaders to just say it. Just say you don’t think certain people deserve the same things you have. You think you deserve it and others don’t. That you work more, deserve more, do better, are smarter… And you can’t really deny it when we’re not having the same arguments with the same vehemence about defense, or any other big budget items. Instead of having a discussion about the real costs, coverage and consequences of the ACA, repeal and remediation, I’m faxing my senators begging them not to let millions of Americans die. And I guess I just expected more.