Tag: ahca

Repeal and Replace

There’s a television show where a group of people go around to auctions and buy ‘stuff’ to resell. They’ll “bid up” the price to screw other people out of money (I expect this is a strategy to prevent competition for upcoming items?) but sometimes get stuck with a high price on something they didn’t actually want because the competition backs out of bidding prior to expectations. I’m worried the AHCA is the guy who overpaid for junk … it started out as a marketing ploy than actual legislation. Pass a repeal and go to their constituents with “*I* got this passed for you (vote for me again), but the bloody rest of the HR stopped your will from being enacted. We don’t have enough Reps, donate NOW and get more R’s in here. Oh, the cursed President said not to worry because he’ll veto the bill — donate NOW and vote for the R. Oh, wait, this didn’t pass the Senate – send money NOW so we can get a super-majority in 2018.

Except it passes the Senate and the incumbents have to live with the results of their legislation. And, yeah, this country has a policy where hospitals need to provide emergency care to anyone regardless of means (they can also bill the person a few hundred thousand dollars, slowly drain away that person’s assets, and file a lien against the estate). Which is great for a relatively health person who suffers a sudden calamity — car crash, fall down a mountain, etc. May not even be terrible for someone who experiences a heart attack. Town halls with Tea Partiers going on about abstract death panels are going to seem like nothing. Wait until the people slowly dying with access only to emergency interventions that extend their suffering start popping up in the town halls — no coverage for the cancer relapse, but you’ll stabilize me and send me home to suffer a few more weeks. People who realize that, sure, an insurance plan *is* available to someone who had a stroke a few years back but how does this state high risk pool with a 250k annual premium help ME? Seniors who lose their subsidies and can no longer afford heath care. People stuck in terrible work situations because losing coverage means the condition will become pre-existing.

Wait until women see premiums quadruple after having a child. My local rep couldn’t tell me if the insurance company would be disallowed from raising my premiums if I self-funded sterilization, provided a doctors note attesting to menopause, swapped over to female partners, or otherwise precluded future pregnancies … and he then he got all annoyed with my expectation that he would have read and, ya know, *understood* the full text of a bill for which he was voting. 

And Republicans will free insurance companies from ACA’s requirement to spend 80-85% of premiums on health services … so all of these sad stories will be coupled with record profits and stock buy-backs within the insurance sector.

Coverage does not equal access

Coverage does not equal access — this political quip used to argue against the ACA is indeed true. Not sure why the answer is not that *no* coverage pretty well ensures no access.

It was a little silly to say that no one would need to change plans or doctors with the new law. Each new annual enrollment period at work, we have different plans and, yeah, I have to change plans even though I liked the one five years ago that had WAY lower deductables, lower out of pocket expenses, and lower cost to purchase. It isn’t available. I remember my mom changing doctors a number of times in the 80’s because her doctor no longer accepted whatever insurance she had at the time. Why one would claim the ACA would change facts that have been true as long as insurance has been about is beyond me. But the claim was made, so it’s a point of criticism for the law.

I guess the implication is that the AHCA will provide both coverage and access. I’ve read the bill … and not heard anyone explain how the changes even provide coverage let alone access. I guess if fewer people can afford coverage, the lucky ones who can don’t compete for appointments anymore. But that’s hardly a selling point for a bill — a bit like saying we’ve increased selection at the grocery store by making sure 18% of your neighbors can no longer afford food.

There’s a balance in the ACA that I don’t really like. But I *understand* that if we are going with the insurance model of health care and don’t want insurance companies to refuse to cover pre-existing conditions, we’ve got to ensure they’ve got customers who aren’t sick. In this light, the proposed changes to the AHCA allowing states make up their own list of essential services makes a bad bill even worse. I’d be able to have “continuing” coverage (and thus not be someone who could be charged a surcharge from an insurance company) by buying the cheapest policy available that covers only sprained left wrists. Then when I *actually* get sick, buy a good insurance policy that covers actual medical care.

Health Care Re-Reform

I am rather shocked that Congressional Republicans did not have an ACA replacement written and ready to go on day 1, but it’s here now. Scott and I were discussing the proposed changes, and he was all for making older pay more to allow younger people to pay less. Because, fairness.

That’s viewing insurance premiums in yearly increments instead of over an entire lifetime. ACA isn’t making younger people pay more for other older people. It is making younger people pay more so they can pay less as they age. The electric company has a level billing option often utilized by people on a fixed income. Instead of having a 150$ bill in winter and summer with 50$ bills in spring and autumn, you have a 100$ bill each month. If viewed as just April’s bill, yeah 100$ is high. But it isn’t like your extra 50$ is going to someone else’s electrical consumption. It’s paying for electricity that you are going to use for AC in August or heat in February.

Young people don’t get screwed in the deal, really. Over an average lifetime, they are going to pay about the same amount. It’s just level billed throughout their entire life. The only way you really get screwed in the ACA system is non-medical early death (a drawn out medical problem, covered by insurance, may well offset insurance premium prepayments). Spend fifteen years paying middle aged kinda healthy person premiums in your youth and then die in a plane crash … never attaining the offsetting bonus of not paying old people premiums. But, seriously, if you die in a plane crash and the biggest downer is the money you’ve essentially wasted on pre-paying health insurance … get some priorities!

Sure, current old people got a steal (same as the first social security payments — the recipient hadn’t spent decades paying into the fund). Old people paid young healthy people premiums forty years ago. They paid middle age kinda healthy people premiums twenty years ago. And maybe they paid a couple of old people premiums before ACA became law. But they’re not looking at paying twenty years of old people premiums. They get 10-20 more years of middle age kinda healthy people premiums. Middle age people get an advantage too — they paid their twenty years of cheap young healthy person premiums and have forty years of middle age kinda healthy people premiums.