Open enrollment is here under the Affordable Care Act. That means we’re in “get ready for crap” mode, where anything and everything that is wrong with healthcare gets blamed on the ACA aka Obamacare. Think Benghazi, only local!
I take the health care thing personally. Pre-ACA, I was uninsurable in the private market, dependent for coverage on AHCCCS (Arizona Health Care Cost Containment System), which had a plan for self-employed individuals. (AHCCCS is Medicaid in Arizona because, well, we’re Arizona. My state was the last state to adopt Medicaid, and we go our own way!) Our insurance program depended on the good graces of the Arizona legislature, a dependency no one should have, ever. (We covered our daughter separately, just in case we lost our coverage.)
Now, I’m pretty healthy. (I just finished a hard 60 minute, 4.5 mile run/walk at elevation on my treadmill, and I’m 57 now.) Medicine controls my mild hypertension/cholesterol. I do have Barrett’s esophagus, a condition that slightly increases my risk for esophageal cancer. I eat well, I’ve never smoked, and I don’t ride motorcycles, sky dive, or enter hot dog eating contests. I could surely drink a few less martinis, but that’s my only vice!
Seems like health care coverage should have been a non-issue for me and my family? Not so much.
I tried the private markets in 2008. First, I looked at a health savings account with a high deductible policy. “No” said the leading provider of these accounts.
Next, I applied under the State Bar of Arizona’s group plan. “No” again. Surprised and annoyed, I called. The nice lady on the phone said the hypertension and cholesterol were non-starters. If they weren’t, though, any policy I got would exclude, always and forever, coverage for gastrointestinal problems. So, I might be insurable without the hypertension and cholesterol, but only if I agreed to self-insure for esophageal cancer and other digestive system diseases. Absurd! I tried one other carrier. Same answer.
Days after Senator Ted Kennedy died in 2009, as it looked like the Affordable Care Act was dying with him, I found myself a job with the firm that employs me now. Did having access to a group health insurance plan decide the matter? No, not at all. Was it a significant factor? You bet, and I would have been a fool not to let it matter.
I offer the foregoing confessional not because my story is unusual, but because it’s a very common story. Our health care financing system, pre-ACA, deprived me of the freedom to protect myself and my family. (Silver lining: I got hooked up with a great law firm, but not everyone’s story ends so well.)
So where are we now? As many as 10,000,000 people may now have coverage who did not have it before the ACA, and people like me have options we did not have before. On a more practical plane, the computers seem to be working well, and good on that!
Premiums have been the subject of many stories. Some say premium increases are modest, but today’s front page New York Times story, Cost of Coverage under Affordable Care Act to Increase in 2015, reports on price increases of as much as 20%, which are not modest by any measure. The story also says individuals can get insurance with lower premiums if they shop around.
Of course, per the article, “Republicans quickly pounced … .” Here’s Senator Orrin Hatch, (R-Ut.), pontificating that:
Last year, many who liked their plan were surprised to learn they couldn’t keep it. This year, many who like their plan will likely have to pay more to keep it.
The premium increase discussion—and the rest of the whining about the process—reflects the anti-ACA crowd’s intellectual dishonesty. Employers have dealt with premium increases and benefit cuts, year after year. Employers and, now, many more individuals, shop for better prices, and yes, shopping for insurance is and always has been hard. Carping about increases and complications only matters in context and, here, it’s as if we all lived in Valhalla until the ACA was foisted upon us.
(A friend has great government coverage. His kids got covered through age 26 because of the ACA. He insisted I was insurable in 2008, and just didn’t want to pay the premiums. And, about insurers, pre-ACA? Constantly complaining!)
There are also people in Congress, puffed up and pluming since November 4, talking about repeal or major fixes. And what do they offer? First, eliminate the tax on medical devices, a change that only affects our national budget and, barely, the bottom line for very successful manufacturers. Second, high risk pools. And, finally, limits on suits against doctors and hospitals. (If their plans include anything else, other than platitudes about markets and not getting between you and your doctor—as if your insurer hasn’t been between you and your doctor for decades—I missed it.)
About those high risk pools. If you’re healthy, you don’t want sick people in your pool. And if your pool only includes sick people, no one wants to insure the lives. Bottom line: Insurance is about sharing risk, and high risk pools are not!
And about medical malpractice suits? Well, if you’re on the receiving end, you don’t like them, but if you or yours suffer as a result of professional negligence, are you ready to have no remedy? A hard-luck life? Regardless, I am aware of no peer-reviewed study which supports the notion that limits will matter, and in states where limits on recoveries exist, neither malpractice nor health insurance premiums have decreased.
One more thing for now. If you want to complain, show up. The Republicans took a pass on the ACA, despite many long months during which President Obama and Senator Max Baucus (D-Mont.)—and the chair of the Senate Finance Committee—courted them desperately. Their choice, and although it has worked pretty well for them from the standpoint of elections, we’d have had a better outcome if they would have joined the party. Regardless, millions of people have coverage, that matters for real, and truth catches up with demagoguery every time.
Republicans fought Medicare just as bitterly in the 1960s. Now, Tea Partiers demand that the government keep its mitts off their Medicare. We’re in for a tough ride about this insurance thing, but in the end we’ll have the same people demanding that no one interfere with their right to have coverage.