It disturbs me that with every stroke of his pen, Trump is pulling another plank from the platform that upholds the lower-and-middle classes of this country. From hobbling workers' rights to decimating healthcare, his and the Republican’s policies are making it tougher for people to live with dignity and be fairly paid for their hard work. So many hard-won fights over so many decades are disappearing before our eyes--workers' rights, women's rights, LGBT rights, minority rights, healthcare rights.

Now the Republican-majority House and Senate are proposing a new healthcare law that guts the Affordable Care Act (ACA) and threatens to leave up to 23 million without health care coverage.

Those between the ages of 50 and 64 will see premium rate increases that will drive many of them to forego insurance altogether. Whereas the ACA prohibited charging older people more than three times what young people were charged, the American Health Care Act (AHCA, aka Trumpcare) will increase that difference to five times as much.

The House Republican Trumpcare plan eliminates the income-based tax credits and subsidies available under the ACA, replacing them with age-based tax credits ranging from $2,000 a year for people in their 20s to $4,000 a year for those older than 60.

The Senate plan is different in that tax credits will vary by income at a lower eligibility level than under the ACA. Sounds good, right? But the credits are smaller because their value is tied to the cost of less-generous insurance than under the ACA. What does “less generous” mean? 

Currently, insurance companies are required to provide coverage for what the ACA termed, “Health Essentials.” These include:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care (both before and after birth)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Under the AHCA, states can waive essential health benefit requirements, allowing insurers to exclude coverage for health care products and services.

So while Republicans—and particularly Trump—are promising lower premiums, they’re also allowing the stripping away of basic services we’ve come to expect for our premiums. Take a look at that list again. Imagine not having coverage for prescriptions, laboratory services, or even hospital stays, and tell me how much “savings” one can really expect in paying for health care. The catch is, these services can be covered by health insurance companies, but for each covered service you “order,” you’ll pay dearly.

• The proposed defunding of Planned Parenthood for one year will affect millions of poor women who rely on the Medicaid-reimbursed care they receive now. 97% of all services provided by Planned Parenthood include basic wellness and early intervention procedures. This, taken from their website, describes what they do to ensure women’s and men’s health.
• Planned Parenthood health centers focus on prevention: 80 percent of our patients receive services to prevent unintended pregnancy.
• Planned Parenthood services help prevent an estimated 560,000 unintended pregnancies in a single year.
• Planned Parenthood provides more than 295,000 Pap tests and more than 320,000 breast exams in a single year, critical services in detecting cancer.
• Planned Parenthood provides more than 4.2 million tests and treatments for sexually transmitted infections, including more than 650,000 HIV tests.
• Planned Parenthood affiliates provide educational programs and outreach to 1.5 million young people and adults in a single year.

The proposed plan makes deep cuts to Medicaid. It ends the Medicaid expansion under the ACA. States will receive less federal Medicaid funding overall. The Senate bill includes deeper Medicaid cuts than the House bill.

These cuts will throw hospitals, doctor’s offices and medical facilities into a tailspin. Expect to see rural-to-mid-sized hospitals close their doors, and doctors discontinue their practices. Expect to see exorbitantly higher premiums for those who are insured, because those folks will, once again, be picking up the cost for those who will no longer be covered by Medicaid. Until the ACA, those who were insured were subsidizing those who were not. Without Medicaid, those who are insured will be doing more heavy lifting than ever.

To explain why this is so, I’ll use my personal history with insurance.

I have made a health insurance premium payment every month of my life since I got out of college. I am now 62, and fortunate to be very healthy. I liked the ACA insurance mandate (gone with this Republican plan) because everyone had some skin in the game. Even if they refused to buy insurance, they had to pay a tax. As a result, for the first time ever in my life, my health insurance premium actually went down in 2017!

It was only eight dollars a month, but it went up year after year before the ACA, sometimes as much as 28%. I rarely even met my then-low $1,000 deductible, yet when I got the dreaded annual letter from my insurance provider, it always said, "This rate increase is not due to your use of health benefits, but the use of health benefits by those in your area." So for decades, I subsidized those who used the hell out of their insurance, as well as those who didn't have insurance.

Finally, with the ACA payments that were made to health insurers by the federal government, it wasn't up to just me and other subscribers to keep subsidizing the costs. The ACA was a relief valve, and the curve flattened. It wasn't perfect, but it was working!

Now that will be gone, and I can't imagine how much my premiums are going to go up between now and when I am eligible for Medicare. But they will go up for everyone, because once again we’ll be subsidizing the uninsured. My insurance provider had originally anticipated 8% increases in 2018, but when the House bill passed, it revised that to 22% increases.

And who will benefit from these massive increases imposed upon the lower-and-middle classes?

The 1%. According to the assessment was made by the Joint Committee on Taxation, a nonpartisan panel that provides research on tax issues, two of the biggest tax cuts in Republican proposals to repeal the Affordable Care Act would deliver roughly $157 billion over the coming decade to those with incomes of $1 million or more. People making $200,000 to $999,999 a year would also get sizable tax cuts. In total, the two provisions would cut taxes by about $274 billion during the coming decade, virtually all of it for people making at least $200,000, according to a separate assessment by the committee.

Repeal-and-replace is a gigantic transfer of wealth from the lowest-income Americans to the highest-income Americans.

Maybe when enough of the lowest-income Americans—many of whom voted for Trump—get  huge increases in their 2018 premiums, they'll wake up and realize that their president, their party, caused their suffering.

I just hope the Democrats ram this fact home and run on nothing but this issue during the 2018 election cycle.

How low can they go? We don’t know yet, but they are plumbing the depths of decency, and we can expect more muck to be heaped upon us as they do.

A friend of mine, at the age of 55, was in a new relationship that was heading towards sexual intimacy. Concerned because she had not had sex in three years, and knowing from experience that it could be a painful encounter because of vaginal dryness, she asked me—a sexually active woman in a twenty-seven-year marriage—what I used to combat that discomfort.

I had a great recommendation, based upon my own experience. The first time I had painful intercourse with my husband, I was astonished. Vaginal dryness came on seemingly overnight, and our lovemaking had to be halted. The next morning, I called my gynecologist’s office and asked to be worked in that day. You see, I love having regular sex with my husband, and I was certain there was a medical remedy to keep that viable, and there was.

My doctor prescribed Vagifem 10 mcg, and after using that small vaginal suppository only a few times, I was back to normal, and so was our sex life.

Vagifem is an estrogen replacement suppository consisting of estradiol. It treats the underlying cause of menopause-related vaginal changes by helping to replenish the vagina’s lost estrogen. It’s used primarily after menopause to treat changes in and around the vagina, including atrophic vaginitis (dryness and soreness in the vagina) and dyspareunia (pain during sexual intercourse.) It is also beneficial in preventing UTIs. The cells lining the vagina are basically the same cells that line the urethra and the bladder. When the vagina is dry, the bladder is dry, and UTIs occur with greater frequency.

There are other such treatments for these afflictions, including patches, ointment, and vaginal rings; but the Vagifem suppository has been very effective for me, so I happily recommended this simple treatment to my friend. She saw her doctor, got a prescription, and began using it. When sexual intimacy occurred the following week, she experienced no discomfort with her new beau. Wonderful, right? I mean, here’s a medical solution for a painful condition, a remedy that can be prescribed by your doctor, and it is covered by insurance.

Until it isn’t.

That same friend called me a few days ago to tell me that her insurance company would no longer cover the cost of Vagifem. She said her out-of-pocket cost for a 90-day supply (24 tablets) would now be $425. My insurance company still covers it under my grandfathered plan, but I have a high deductible, so my out-of-pocket cost for a 90-day supply is $546. But because it is a covered medication, it at least goes towards my deductible. Not so for my friend. The total cost is now hers to bear. Thankfully, my friend and I can afford Vagifem, but many women cannot.

The Affordable Care Act did a great thing in mandating that plans in the Health Insurance Marketplace cover contraceptive methods and counseling for all women, as prescribed by a health care provider. Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider, even if a woman has not met her deductible. If her employer is granted an exemption to pay for a plan that covers the cost of birth control based on religious reasons (Hobby Lobby) the insurer will provide birth control coverage to the company’s female employees at no additional cost to the company. Birth control addresses both pregnancy prevention and women’s health issues, such as regulating periods, stopping menstrual migraines, easing endometriosis, helping with polycystic ovarian syndrome, and reducing the risk of endometrial cancer. Vaginal estrogen replacement medication address multiple symptoms related to women’s health, so why shouldn’t it be covered as well?

In doing some research, I ran across plenty of forums with discussions that date back years, with post-menopausal women complaining that their health insurance would not cover treatment for their symptoms, because they consider “hormone-level decline a normal part of aging.”

Medicare Part D covers much of the cost for Vagifem, but atrophic vaginitis and dyspareunia occur in women much younger than 65. So why would some private insurance companies not cover a medication that is essential in alleviating a post-menopausal woman’s painful dryness symptoms? Are vaginal dryness, UTIs, atrophy and the related pain not legitimate medical conditions?

Or is it just that the vaginas of women who can no longer reproduce are considered—well, not worthy of  consideration? Are we just supposed to dry up and blow away?

Aging takes enough of a toll on women mentally and physically, and our desire to stave off this particular painful biological effect of aging should not take a large financial toll as well. Aging gracefully simply cannot occur if a woman who wants to have sex cannot do so without pain. Which makes me wonder: How did insurance companies arrive at the conclusion that women should personally bear the cost of treating the medical conditions known as atrophic vaginitis and dyspareunia? Which executives decided that women not of child-bearing age should pay such a high price to maintain a healthy vagina, one that is still primed for pleasurable intercourse? This isn’t plastic surgery, an optional choice for looking younger. This is a medical issue of alleviating pain and maintaining the health of the most vital area of our feminine realm. It should not be optional based upon affordability.

If we remain healthy, we can enjoy sex long into our “old age,” given the availability of erectile-dysfunction pills and vaginal atrophy treatment. If women want to enjoy sex after menopause, but before age 65, they may have to pay dearly for it. Our sexuality is being devalued by tight-fisted insurance companies. The ACA gives us the right to appeal such insurance company decisions through an internal appeal or an external review. If every woman who is denied coverage for FDA-approved atrophic vaginitis remedies appealed, we might be able to reclaim our right to painless sex for decades before we are eligible for Medicare.

REKINDLING THE TORCH OF CHOICE

Those of us who are over 50 have reached that comfortable age when we no longer have to worry about an unintended pregnancy. For us, the issue of reproductive choice has faded in importance. But for our daughters and granddaughters of childbearing age, it should still matter—now more than ever.

Those of us who became sexually active in the 70s had protections in place to safeguard us from unwanted pregnancy. In 1972, the Supreme Court ruled that unmarried women could legally be prescribed birth control pills. And then in 1973, the landmark Roe v. Wade decision gave women the right to make decisions about whether or not to have an abortion. These protections are still largely in place in 2015. However, with the aggressive anti-choice agenda being pushed by state and federal lawmakers, that may not be the case by the next presidential election.

I’ve always advocated choice, simply because I felt another person should never have any say over any decisions regarding my body. Choice dovetailed with the years I became sexually active, and my reproductive choices were protected under the law.

Legal protection of women’s reproductive choices has been under relentless assault for some time, and those efforts are escalating. Republicans in Congress, emboldened by their new majority, introduced five abortion restrictions in the first three days of the new legislative session! Their proposed restrictions would severely limit women’s access to abortion. Politicians are inserting themselves in the most private and personal medical decision that should be left up to a woman and her doctor.

What is truly baffling is their quest to defund Planned Parenthood. One in five women visits a Planned Parenthood clinic at least once in her life. Why would Republicans want to defund Planned Parenthood when it helps to prevent more than half a million unintended pregnancies each year, thereby making the need for an abortion moot? It seems irrational, and at cross-purposes. Yes, Planned Parenthood is there when a woman needs abortion care, but performing abortions is only three percent of the many services they provide. Why inhibit a woman’s access to birth control, pelvic screenings, breast exams and other health-and-reproductive-related services?

We are going backwards, and the generations of women who are of child-bearing age do not seem meaningfully motivated to halt this persistent march back to the days of no choice. They’ve lived with the victorious results of a hard-won battle that raged through the 60s and early 70s. That is ancient history to them, but it isn’t ancient history to those of us who saw the battle being waged and first benefitted from its accomplishment.

The Women’s Liberation Movement, like the Civil Rights movement, required organization, dedication, and unification to be recognized. The impetus for that kind of solidarity is not there today. The pro-life movement, on the other hand, has burgeoned and is gaining strength day by day. Both the Civil Rights and Women’s Liberation Movement brought about positive changes in society. Imagine if legislation were being churned out to prohibit African-Americans from having the same rights as white people, such as drinking from the same water fountain? Would you not think, That’s nuts! They can’t do that! We’re way past that!

Why aren’t women reacting as strongly to the potential loss of their right to make decisions about their own bodies?

Perhaps it is because we older women have become unworried, since we are no longer personally affected. Maybe it is because younger women don’t know about or can’t relate to the horrors of backroom abortions. They may know women who have had an abortion–a safe, legal medical procedure; but they don’t know women who died from a botched abortion.

The Nineteenth Amendment that gave women the right to vote was also hard fought for and won. Think about how you took for granted your right to vote when you turned eighteen. In that same way, younger women are taking for granted that they will have reproductive choices in the future. But that is not so. Even access to birth control, as we can see by the assault on Planned Parenthood and the SCOTUS decision in the Hobby Lobby case, is under attack.

It is time for women of every generation to stop taking choice for granted. Let’s acknowledge that the Republican’s answer to birth control—total abstention—is unrealistic, and that it is up to us to keep birth control and safe abortions accessible. This is going to require our generation’s involvement. Those of us who enjoyed virtually worry-free sex must educate younger women about how difficult it was when women had no access to birth control or safe abortions.

It is time for our generation to rekindle the torch of choice, and to pass it down. It is time for us, the most outspoken, inspiring and audacious women in history, to shake women of all ages out of their complacency! Our legacy should be the empowerment of younger women in constructing stronger, independent lives that aren’t lived according to ideals imposed by men. It is our duty to encourage them to fight for the continued right of choice, so that they can in turn inspire the generations of women who come after them to do the same.

We are not too old to take up the battle. Let us give others the benefit of our experience and knowledge. We lived it, so we can talk of it with intelligence and confidence. Let’s start by engaging our daughters, granddaughters, and young friends in meaningful conversations about what the loss of choice will mean for them. Let’s emphasize the value of their vote, and enlist their support of organizations that support choice, like Planned Parenthood, NARAL and Emily’s List.

Let us not go gently into our golden years. Instead, let us reinvigorate and do what we can now to help preserve a woman’s most fundamental right—the right to have total control over her own body.