Bill and His Family Keep Their Health Insurance, at Least for Now
categories: Cocktail Hour / Don't Talk About Politics
4 comments
A little neck repair–while I still had COBRA coverage.
Happy this week to know that at least for a while, my family’s insurance (and of course that of many millions of fellow citizens—or really all citizens, as the ACA’s protections extend into everyone’s insurance) is safe. It’s been disheartening to watch republicans try to make good on their campaign pledges to repeal and replace the Patient Protection and Affordable Care Act, which they made sure to call Obamacare. They didn’t fail because democrats wouldn’t work with them—they didn’t ask democrats to work with them. They failed because their bill worked from a lie, that the ACA is in some kind of death spiral. It isn’t.
The republican professional assholes failed because their stated reasons for the urgency of repeal (that death spiral, supposedly soaring premiums, high deductibles, too few people covered) were not their actual reasons, not even close—their replacement bill didn’t fix any of those things. And those actual reasons were why republicans couldn’t get the required votes in the House of Representatives: factions among them don’t agree.
The further right, the so-called Freedom caucus, just hate socialism, and social medicine is the poster child for that hatred, always was.
Welfare, too, which takes us to the racist right, operating from hatred of Obama and the wish to repudiate everything about him, especially Obamacare, which they see as more handouts to the poor, a group their imaginations tell them is largely Black and undeserving.
Then there is the corporate right, which is almost all of it, who don’t want any barriers to moneymaking, including regulations that require insurance companies to actually provide insurance in exchange for the soaring premiums they extract. Yes, the soaring part is about the insurance companies, not about Obama.
Finally, there’s the moderate right, who may actually see the need for healthcare insurance for all, but who want a market approach. It’s they who kept the insurance industry involved in Obamacare, when most democrats wanted at least a public option, something like Medicare for all who wanted it (Bernie Sanders is introducing such a bill in the Senate this week), something that would operate side-by-side with the market driven system already in place at that time (talk about soaring premiums and high deductibles! My own deductible before the ACA was $30,000 per person, and the policy covered only major accident and illness, though your carrier could drop you at will, that is, at the exact moment you reached your deductible).
The far right couldn’t stomach even vestiges of social medicine, the moderate right wasn’t going to get reelected without those vestiges, and that and nothing else is why the votes weren’t there.
President Trump promised insurance for all for less, better insurance with lower costs. That’s because he hadn’t studied the problem, so it seems. Because the ACHA, which I hope forever is called Trumpcare, didn’t offer any of the things he promised. And even his own voters knew that. It was widely reported that Trumpcare polled at 17%, disastrously low. And even that figure amalgamated two choices Trump friendly poll respondents had ticked off: Support, and strongly support. Strongly support got only 6%. Why? Because the bill was predicated on a series of lies, eight years worth. And yet most republicans voted for it. And more, apparently, would have voted for it if it had been even less likable. Why? Why? Why? Because they are idealogues on the one hand (no socialism!), and corporate hacks on the other (no regulation! profits before people!).
Fun watching the republicans, having gotten the ball on downs (or was it an interception?), fumble so spectacularly. But these trick plays seldom work.
Joe Barton of Texas put it best: “Sometimes you’re playing Fantasy Football and sometimes you’re in the real game. We knew the president [Obama], if we could get a repeal bill to his desk, would almost certainly veto it. This time we knew if it got to the president’s desk it would be signed.” Eight years of fantasy football. And now you find yourself on an actual field. One where Obama played very well, and played for real.
Trump says the next step for republicans is to let Obamacare explode, or implode (depending on his mood). No doubt he and Secretary Price have plans to help that happen: put sand in the gas tank a handful at a time and blame the car when it breaks down. They must be watched closely, and resisted decisively at every turn.
[Here’s a good Atlantic article about the ways the Trump administration could seek to weaken and ultimately destroy Obamacare, which as of this writing is going strong.]
I agree the replacement bill put forward did nothing to improve the problems with the ACA. And there are problems. Of course, like most things in life, your view depends on your seat. There is no doubt the ACA was a huge benefit to many people. Most specifically, those making between one and four times the Federal Poverty level ($40,000 a year or so if you are single, much more if you are married). If you have one of those seats, the ACA was a Godsend (sorry Dave). Those individuals receive a premium subsidy and if you make two times the poverty level or less, you get your deductibles and coinsurance subsidized as well. The ACA can only be viewed positively for that part of our population.
The other winners were the uninsurable. The previous system left it up to the states to handle (or not) those individuals who could not participate in the old system. Some states (Missouri) had a Pool for the uninsurable/high risk population that in fact was cheaper than a non-subsidized ACA plan and better coverage. Other states didn’t and that was clearly a problem.
So the ACA was/is beneficially for those two groups. Who is complaining? The rest of the world. For those who are NOT subsidy eligible and were/are insurable the cost of individual coverage thru Community Rating and the ACA was/is 20%-50% higher than prior to the ACA. That is why most individuals continue to cling to ‘grandmothered’ plans and hope each and every year they can keep it ‘one more year’. If/when they are forced to a ACA community rated plan it will be a disaster. For those few who an ACA individual plan was more attractive and moved to one, they have seen a massive erosion in benefits, networks, rx formularies combined with skyrocketing costs. The ACA rates in Montana for this year went up over 50%. I would call that spiraling. Of course, if you are on a subsidy, this is not significant and you are insulated from these increases because the ACA guarantees you will pay a % of your income not a % of the premium. Non-Subsidized ACA coverage for a Silver Plan costs over 17,000 per year for a family of 4 making $100,000 a year. The same family making $50,000 will pay less than 5000 for the same policy. And next year when rates go up 20%, the family on subsidy will still pay 5000…
The ACA is/was a program to subsidize the lower income portion of our population and include the high risk/uninsurables. Those are certainly laudable goals and one could argue that we should indeed have done that. However, that is not how the ACA was sold at all. It was sold as a program that would benefit us all, making healthcare more Affordable and Accessible. In fact, for most of the country, it has done neither. In order to subsidize lower income premiums and insure the high risk, the rest of the country HAS to pay more. It is simple math.
Fixing the healthcare problem is going to take more than a repeal or a replace that was thrown together in 30 days. The ACA has indeed helped many but failed many more. Most people’s view depends on their seat…
I agree, partly. The ACA didn’t make much difference to employer-provided plans already negotiated. But it helped self-employed middle earners enormously. The huge premiums some self-employed people pay under the ACA go to the insurance companies, and are set by them and were insisted upon by them as the ACA went through the sausage grinder. To retain my plan before the ACA when my COBRA ran out with the same company at the same level would have been $72,000 a year, with no employer to negotiate for me. Of course I couldn’t do that, and the best I could manage was $30,000 deductible per person, at a cost of about 8,000 a year, with no protection against being dropped for any reason at all, and zero drug coverage, etc., etc., things that the ACA cured for everyone. Let’s eliminate the insurance companies for those people by offering Medicare for those who want it. And agree that, yes, someone has to pay for it. That’s how a healthy society operates. But you’re right, the ACA needs fixing. Breaking it or killing it doesn’t fix anything. Trumpcare didn’t fix anything, except to eliminate some taxes on the very richest. Medicare for all who want it will cost less, work better, and fulfill Trump’s rather stupid campaign promises.
Let’s call it “trump didn’t care”
He certainly seems not to! Except to wreck things.