ACA, AHCA, Obamacare, Trumpcare…more of the same

Before the adoption of the Affordable Care Act, also known as Obamacare, I was approached by to make an ad for them. Their request was as the result of my commenting on an article they had written about the need for health care reform. At the time we had dropped our bare bones, high deductible health insurance. The premiums were going up by double digits in most years. In those years when we hit another decade in age, the increases almost doubled. Every year we increased the deductibles and the out-of-pocket maximums, but still the premiums were so high that we could not afford even the basics of medical care. I had written opposing adoption of the Affordable Care Act and advocated for as single payer, Medicare-for-All option.

I spent a couple of days with make up artists, a film crew, script writers and producers from  the activist organization. My ad aired on television stations around the region. The reaction from people I know was surprising. Some of my friends pretended they hadn’t seen the ad. Others expressed concern that we were putting our farm at risk because we had no insurance. At least one person offered financial assistance. A few friends told me they envied us. They wished they had the courage to quit the job they hated, but they felt trapped because they were too afraid to let go of the insurance that was part of their job. Some people I didn’t know sent me hate mail. They had been misinformed that those of us without insurance got free health care at the expense of everyone else.

The reality was that without the bills for insurance premiums and with the good fortune to have good health, we were able to put aside money to pay for basic health, dental and eye care. These were things we had gone without when we had insurance. We usually paid the billed amount for these services, or at most received a 10 percent discount for paying immediately, not the “negotiated” discounted rates paid by health insurance companies. We didn’t receive “free” services.

I supported parts of the ACA such as not being refused coverage for pre-existing conditions and covering young people to the age of 26. I thought standardizing coverage for different levels of insurance made shopping for coverage easier. Subsidies for purchasing insurance helped a lot of people obtain coverage they could afford. Limiting the amount of money insurance companies could pay their executives and setting the level of premiums that needed to go to actually providing medical care were also good starts.

The ACA and the new American Health Care Act (AHCA) proposed this week by House Republicans both have a basic failing. The assumption is that buying health insurance and health care services are like buying anything else. Consumers will shop around for the best deal, the cheapest provider, the lowest cost option. The “free market” will bring lower prices and better care. That simply is not the case. I want the best doctor treating me when I’m sick. I don’t want the equivalent of an economy airline flight where I need to bring my own food and water. When someone is told, “You have cancer,” the patient and his family wants the best available, no matter what the cost. We might look for the most effective treatment, the doctors with the most experience, and the best outcomes, but we rarely ask, “How much is this going to cost?” The life of our child, parent or spouse is worth more than money to us.

President Trump is right about one thing. Health care is a very complicated issue. It is made more so by the power and influence exerted by an industry that is making big returns on our fear of being ruined by a major illness. The plan offered by President Trump and the Republican Congress is not even a band-aid. It will keep a few of the more popular provisions of the ACA and it will drop the mandate that everyone buy insurance. Employers won’t be required to provide insurance to their employees. However, you will be penalized by a 30% increase in your premiums if you let your insurance drop for more than 63 days. It will raise the allowable pay for insurance company executives and it will eliminate the tax on the most expensive insurance plans and the wealthiest of Americans which paid for the subsidies for the poorest. There will be no consistent coverage between plans and the Medicaid expansion will be rolled back and replaced with per capita block grants to states. It will allow marketing insurance policies across state lines, eliminating states’ rules about minimum coverage requirements. It will give insurance companies the freedom to sell extremely high deductible plans that cover nothing.

This will be worse than the ACA for the majority of Americans, not better. It will not solve the problem of the cost of health insurance and health care. It will not help those of us who live in rural areas to be served by more health care providers.

Since my brief starring role in a television ad, my spouse and I have reached the age of Medicare eligibility. We pay a premium for Medicare B and for our supplemental insurance. The total cost is a fraction of what our high deductible insurance cost more than ten years ago. It covers almost everything. We’ve had no problems with bills not being paid or with necessary care being denied.

Everyone should have access to the same.