Browsing the pages of YouCaring, a crowdfunding site established in 2011, reveals a slew of tearjerker medical fundraisers—from the family of a four-year-old with cancer to a human trafficking survivor who needs reconstructive surgery. You'll find similar fundraisers at GoFundMe (an early entrant in the crowdfunding scene in 2010), Plumfund, and Indiegogo's Generosity.
Have I traveled forward in time to provide you with a terrifying dispatch from a post-ACA future? Nope. In 2015, researchers found that more than a quarter of Americans reported struggling with health care costs. Insurance isn't a silver bullet.
That's why medical expenses remain the single largest crowdfunding category, even with the Affordable Care Act in place, with Anne Helen Petersen at Buzzfeed noting that they're also a sick kind of popularity contest. If you'll forgive the pun.
When people run up against the limits of their insurance policies, they turn to friends and strangers on the internet in the hopes of raising thousands of dollars to pay for procedures insurance companies refuse to cover. Some are worried about mounting copays, equipment, and procedures that aren't covered, the cost of weeks or months off work, or the loss of a family breadwinner.
The dystopian landscape for medical crowdfunding is great news for the entrepreneurs that build sites like YouCaring. In 2015, Nerdwallet found that about 40 percent of crowdfunding campaigns on major platforms were medical in nature, and that only 11 percent were fully funded, but still raking in percentages for site operators. This situation is pretty much a bummer for the rest of us, and from the looks of the GOP's "health care" proposal, it's about to get a lot worse.
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Several mechanisms in the GOP bill could exacerbate health care inequality in America, driving more people to medical crowdfunding. But it's a bit of a double-edged sword, because increasing inequality will reduce disposable income for many Americans, making it hard for generous-hearted people to contribute to those in need.
The biggest immediate concern is the rollback of the Medicaid expansion, which covers more than 14 million Americans who are too poor to buy insurance on the open market while making too much to qualify for Medicaid itself. Next, severe cuts to Medicaid are likely to put extreme pressure on low-income Americans—procedures, medications, and other medical needs once covered may be cut from state budgets.
Republicans have assured Americans that there will still be protections for people with preexisting conditions, but those claims don't stand up well to a closer look. First, there's the plan's proposal to allow states to waive the Ten Essential Benefits currently required for marketplace plans. Coverage for things like mental health and maternity care could simply be dropped. Moreover, because annual and lifetime benefit limits only apply to the Ten Essential Benefits, this will de facto create a situation where people can max out their insurance coverage.
A complex premature birth, advanced cancer, or major medical event could mean that someone runs out of coverage before even leaving the hospital. Once booted from insurance, patients will have trouble finding coverage they can afford due to changes to the community rating system that sets standardized pricing for insurance. Companies can't refuse to offer coverage to people with preexisting conditions, but they can charge more for it and add exclusions that make the policy largely worthless.
Oh, and did we mention the six-month waiting period Republicans want to institute on people who drop their insurance—or are kicked off it? Their solution to eliminating the individual mandate is to punish people who don't have insurance by making them wait six months before they can establish new policies. If your premium skyrockets (which it will) and you miss a monthly payment, you could get caught in this trap. Yikes.
By 2026, the Congressional Budget Office estimates, 22 million people could lose their insurance. Others may be stuck with policies that are functionally worthless. It's clear that this will contribute to the boom cycle for medical crowdfunding, with more people turning to the kindness of strangers in the hope of getting out of medical debt or funding urgently needed procedures. In a way, though, the explosion of pleas for help should be viewed as the symptom, not the disease.
The United States is somewhat unique among industrialized nations, spending more than any other OECD country and getting, comparably, a lot less. While medical debt is pervasive in the US, nations with nationalized medicine seem capable of providing a high quality of care across the board with far lower expenditures. Their residents often seem perplexed by the ubiquitous nature of crowdfunding in the American medical ecosystem.
Health care disparities are a clear reflection of economic inequality. Wealthy Americans and those working at large companies with generous benefits packages will be insulated from many of the effects of Trumpcare. The working and middle classes, however, will not fare so well, lacking the freedom of consumer choice, and the clout, that comes with money.
Low-income Americans turn to crowdfunding as a final act of desperation. While health care needs can be neglected, eventually patients hit a wall—the excruciating tooth ache turns into a ruptured abscess, the strange lump becomes an ulcerated tumor—and they're forced to seek care they can't afford because the alternate is death.
By reducing access to coverage, and relaxing the mandates on what insurers must provide, President Barack Obama said recently, Republicans are enacting a "massive transfer of wealth from middle-class and poor families to the richest people in America." He's not wrong.
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Update 8/9/17: A previous version of this story had a photo and link to a crowdfunding page that has since been changed.