And yet, as much as any single issue, it’s about health care.
asserted
it → ’ → care
You can tell by listening to all the Democrats talking about high deductibles, drug costs, and insurance companies as they campaign around the country.
asserted
they → tell → country
Or you can tell by reading all the public-opinion surveys in which voters consistently rank health care as one of their top concerns.
asserted
voters → tell → concerns
But if you really want to know why this is a health care election, your best source isn’t the politicians or the pollsters.
asserted
source → want → ?
It’s the people on the front lines.
asserted
It → ’ → lines
One of them is Raymond Rion, a family medicine physician and executive director of Packard Health, a small network of clinics spanning Ann Arbor and Ypsilanti on the western outskirts of the Detroit metro area.
asserted
One → span → area
Packard is what’s known as a Federally Qualified Health Center, where anybody can get care regardless of income or insurance status.
asserted
anybody → know → income
And like similar safety-net providers all over America, for the past decade it has benefited directly from the Affordable Care Act.
asserted
it → benefit → Act
“We almost went bankrupt in 2011,” Rion told me in a conversation last week, recalling how in the old days staff at Packard would work the phones furiously to get supplies and find specialists who would take referrals.
asserted
who → go → referrals
Now many more patients have either Medicaid or private coverage they’ve purchased through HealthCare.gov, the online marketplace that the law created, so that the proportion of uninsured patients has fallen from around one in three to one in ten.
asserted
proportion → have → ten
It’s a lot easier to find referrals for these insured patients, though thanks to the infusion of paying customers Packard can do much more on its own.
asserted
Packard → ’ → own
In particular, Rion said, the organization has opened two new branches, started a pharmacy, begun offering prenatal services, and vastly expanded behavioral health care by bringing on a half-dozen new doctors, nurses, and case workers.
asserted
organization → say → doctors
Coverage options on the HealthCare.gov marketplace got more expensive because Donald Trump and the Republicans refused to renew temporary subsidies that had been reducing the price of insurance.
asserted
that → get → insurance
On top of that, the first cuts to Medicaid as part of last year’s “One Big Beautiful Bill” are starting to take effect.
asserted
cuts → start → effect
Rion told me Packard has already laid off a provider in anticipation of less revenue next year.1
asserted
Packard → tell → revenue
Patient volume is down, he went on to explain, in part because uninsured patients sometimes avoid care altogether out of fear a single visit will lead to more treatments with more bills.
asserted
visit → go → bills
And postponing care in that way can have serious medical consequences, as his colleague Ron Romero told me.
asserted
colleague → postpone → me
“So you have somebody with diabetes, their chronic condition isn’t getting cared for,” said Romero, who like Rion is a family physician.
asserted
who → have → Rion
“Their sugars rise, and they end up having other medical problems.
asserted
they → rise → problems
Their kidneys start to get damaged.
asserted
kidneys → start → ?
They start to have eye damage.
asserted
They → start → damage
They increase risk for heart attacks and strokes.
asserted
They → increase → attacks
They end up in the emergency room.”
And things are likely to get worse.
asserted
things → end → room
Partly that’s because next year most of the remaining Medicaid cuts will take full effect, throwing more people off coverage.
asserted
most → ’ → coverage
And partly it’s because forces that have nothing to do with Trump or Republican actions are making medical care more expensive for everyone, including those with employer insurance and Medicare.
asserted
care → ’ → insurance
That will lead to still more people delaying or skipping care, ending up in the emergency rooms, and putting yet more cost pressure on providers.
asserted
people → lead → providers
Rion wasn’t taking a position on the election or political parties, he made clear.
asserted
he → take → election
He was just describing the reality he sees around him: “The whole system is being pressured.
asserted
system → describe → him
He’s right.
asserted
He → ’ → ?
And here’s the thing: This has all happened before.
asserted
This → ’ → ?
We know happens next.
asserted
We → know → ?
The Aporia
