Hey, the bad guys didn’t win this round. That may not qualify as victory per se, but for the 15 million who would lose their insurance within the year (and the 22 million by 2026) it’s not the slaughter that seemed inevitable given that the government — all branches but the DMV — is controlled by Republicans. The great splashing sound you won’t hear is that of the women and orphans being tossed overboard, at least not this week. Not even the mouth-watering prospect of defunding Planned Parenthood, it turned out, was enough to unify the seismically fractured Republican Party behind its plans to deep-six the Affordable Care Act (ACA). For the time being — at least two weeks — the ACA remains the law of the land. That means insurance plans will still cover the cost of pharmaceutically induced erections that can last four hours if they’re proved to be a medical hedge against depression. Likewise, maternity care must still be covered, despite Republican insistence that states should have the right not to require this. So much for motherhood and apple pie.
For Santa Barbara — socked in by the most oppressive June Gloom to occupy the southland since, well, last year — the big news, of course, is the unfortunate limbo in which the much-beleaguered tanning salon industry has found itself since the passage of the ACA, which imposed a special tax on these businesses. Not everyone, it turns out, is as at ease with their fish-belly whiteness as I am. For such people, summers can be cruel without the sanctuary of a tanning bed unto which they can retreat. Taxes were also imposed on real medical device manufacturers and people making scads of dough — to help underwrite the massive government subsidies, roughly $800 billion. Those subsidies bought insurance for people who were legally required to have insurance but could not otherwise afford the premiums. This level of transactional complexity, by the way, is exactly what’s driving the surging popularity of the single-payer universal-health-care movement that currently has half the Democratic Party trying to chew the face off the other half. So much for the solidarity of resistance.
As Republicans struggle with what to do about women — certainly not appoint them to any committees making health-care policy — they have embraced the tanning salon tax as a demonstration of their concern for the “better half,” also known as the “weaker sex.” The Republican argument is that the 10 percent tax imposed on the tanning salon industry oppressively targets women because women, it turns out, avail themselves of these contraptions far more than men. In fact, they have cited studies purporting to show that $480 million of the $600 million in taxes collected from tanning salon operations have come from the pockets of women. That this is as close as Republicans can bring themselves to standing up for women might explain why males of this species feel so oddly compelled to repeatedly point out that they, too, have wives, mothers, and sisters.
In an effort to understand — rather than merely mock — the plight of tanning salons under the ACA, I dispatched not one but two interns to interview as many salonistas as they could get on the phone. To ensure the factual integrity of whatever information they uncovered, I purposefully did not tell either of these interns about the other’s existence. Scientifically speaking, we established that there are “a lot” of such salons in town. Or at least “a lot” listed on Google. In fact, there are “a lot more” than I expected. Strangely, “a lot” of them were not open. The very few that were didn’t really know what the interns were asking about even after the interns explained it to them. In fact, only one operation was both open and conversant. That was a spray-on tan clinic. Spray-on tans, by the way, are not taxed to pay for affordable care. They cost $45. And you need to take a shower beforehand.
Tanning salons wound up getting taxed because the government needed hundreds of billions to pay for the ACA and it had to come from somewhere. It was a tussle between tanning salons and the Botox doctors. The Botox dox won. Reportedly, around 9,000 tanning salons have since shut down. Maybe that’s why no one answered the phone. Maybe skin cancer rates — especially for women — will drop, too. I don’t know.
What I do know is this: 46,000 low-income people in Santa Barbara and San Luis Obispo counties qualified for Medicaid under the ACA’s expanded eligibility provisions. Eighty percent of people on Medicaid live in households where at least one person works. In 2016 some studies showed that, because of the ACA, new Medicaid beneficiaries had 7,500 medical appointments to treat breast malignancies. The second leading cause of office visits for this newly insured population was type 2 diabetes, followed by hypertension and renal disease. All these, I know, can land you in the hospital. Hospitals — under the ACA — could deal with uninsured sick people by having them declared “presumptive Medicaid-eligible,” meaning the government would pick up a portion of the cost. Under the Republican’s Senate bill, those powers would be revoked. I also know that in 2009 the American Journal of Public Health published a Harvard study showing that 45,000 of United States citizens die each year from not being able to afford medical care. Those without insurance had a 40 percent higher risk of dying than those who were insured.
The ACA may be seriously crazy, but America is a crazy, great country. So happy Fourth of July.