Mandates, deductibles, pre-existing conditions, Medicaid, subsidies, waivers, premiums……if you have paid any attention to the news lately, you have heard all of these words. Do you really understand the “healthcare speak” we are inundated with day after day? The news media, opinion pundits, and government officials confuse many and muddy the waters with double-speak angled left, right, or insane. Rarely is there a middle-ground. That is where this article comes in…attempting to provide some healthcare middle ground.
As a person who has experienced being insured, uninsured, on Medicaid, and now on Employer-based insurance, I have a different view of healthcare than most. We have gone through times of want and times of plenty, and our insurance status matched our financial situation…until the ACA. We were doing well with no health insurance until the ACA mandated us to purchase it, at a premium of about $350 per month at the onset of ACA. Last year, that same insurance policy was costing nearly $800 per month. This year, the employer offering our family healthcare benefits was forced to provide Obamacare for employees instead of the high quality of insurance they used to provide, and it costs nearly $500 per month, but covers very little even after meeting the deductible…which we had already met by March of this year due to an onslaught of medical issues. Our current policy is with the only provider in our county, and we had 2 options within that provider. We can no longer go to the doctors we liked and trusted. We cannot even use the pharmacy we like. Instead, we are forced to order from the only pharmacy our plan allows, and at higher out-of-pocket costs than we had on the previous plan. Example: medications for 2 people in my household that cost a combined $16 per month in 2016, now cost $150 every month, and that is AFTER the insurance pays their part. With many of us on medications for various things, it adds up quickly. This problem does not just belong to my family. I have heard similar stories repeated from my friends and family.
One-size-fits-all healthcare is what the ACA makes available to all. That may sound great! One plan for women, men, grandparents, babies, college students, and everyone in between. “Having only one product should help reduce costs for all,” they have told us, but it does not. Here is a scenario to help you understand why one-size-fits-all healthcare is problematic:
A 50-year-old unmarried bachelor enters a clothing store to purchase new socks. All he needs is socks. The store clerk shows him the two kinds of socks the store sells (the man is fortunate since some stores only carry one kind of socks). The man chooses the pair he wants and proceeds to the checkout to see a mound of clothing sitting by the cash register. Included in the pile are women’s panties, a bra, men’s boxers, a child’s dress, a tie that would only fit a young boy, a fancy ladies’ hat, and high heels. The man looks confused and asks the clerk why the extra clothing is there. He is told he must purchase these extra things every-time he buys socks. It is mandatory. He finally gives in, but leaves unhappy that he must pay so much for so many items that he will never use.
A 25-year-old mother of 3 girls and 1 boy enters the same clothing store in question. She has a list of items she needs, including a pair of socks, panties, a bra, a child’s dress, and a young boy’s tie. By the time this young woman drags both her kids and purchase choices to the checkout counter, she is exhausted. Seeing extra items in the pile at the register, she asks what is happening. Like the man before her, she is told this is part of her purchase and she must buy all the things in order to get the list of what she originally wanted. Upon further inspection, the mother decides that her husband and children may eventually need everything in the pile, and there are only 3 mandated purchases that were not on her original list. Hesitantly, she pulls out her almost maxed credit card and prays the purchases will not be declined. The kids cheer when they hear the register bell ding, knowing that they can finally get out of that store and eat lunch…hopefully…if there is any money left to buy it.
Both characters in the scenario paid the exact same price and left with the exact same items. The difference is that one customer’s needs do not equal another’s needs. People who need to buy fewer items should not be forced to buy more than they need. The same applies to healthcare. We say we celebrate diversity and uniqueness, yet we lump everyone together and rob them of diverse choices in healthcare….not to mention robbing them of their hard-earned income to pay for it.
Here are the facts of both healthcare acts, as we know it:
The Affordable Care Act (Obamacare/ACA) is the first federal healthcare initiative to pass both the House of Representatives and the Senate. It was passed as a partisan bill, with no Republican votes, and signed into law March 23, 2010. Before passing, the American people did not have the opportunity to read the bill in its entirety but were given a basic outline of its contents. Nancy Pelosi, then Speaker of the House, famously said, “We have to pass the bill so that you can find out what is in it, away from the fog of controversy.” The ACA is made up of “906 pages of terms and conditions…and thousands of pages’ worth of additional regulations” (Health Network Group, 2017). Few have actually read the entire bill, but what we know for sure about the ACA is:
1) Every American is mandated, or forced, to purchase healthcare coverage that meets the ACA standard or must pay a fine for non-coverage. This mandate is enforced through income taxes.
2) Pre-existing conditions (cancer, diabetes, Multiple-sclerosis, etc.…) are covered with no difference between premiums of the healthy and those who need extra care. So, everybody pays for extra coverage even if they do not need it.
3) The federal government pays insurance companies money to subsidize, or financially support, the premiums of those who cannot afford them based on their income. These subsidies are tax-payer funded, or added to the national debt by printing more money.
4) Medicaid was expanded to cover more people by broadening the stipulations of those able to gain Medicaid coverage. “Current ACA Medicaid funding is based on an open-ended matching system” (Health Network Group, 2017), where the government pays $1 for every $1 the state spends on Medicaid coverage. States are incentivized to expand their Medicaid coverage to get more federal dollars. Medicaid patients pay little to nothing for healthcare, although some must pay a small premium based on income.
5) Members of Congress and other government officials were not subject to the ACA as of 2016, but this may change soon (Health Network Group, 2017).
We were told by President Obama that premiums would go down dramatically because of the ACA. However, The ACA national average premium has more than doubled since its inception (Gaba, 2016) (Gabba, 2017). We were told we could keep our doctor and our plan. Very few of us have been able to keep our doctor, our plan, or our pharmacy (Restrepo, 2016).
The American Health Care Act (Trumpcare/AHCA) is the Republican response to the ACA. It was passed in the House of Representatives after being revised and amended, and is only 132 pages long…total. To download the AHCA, go to https://housegop.leadpages.co/healthcare/. IF the AHCA makes it through the Senate, it will look very different than it does today. The Senate will amend and revise the AHCA before sending the bill to a joint conference, which will change it even more before sending it back through the House and Senate and ultimately to the President. So, while these facts are subject to change in the coming months, this is what we know of the AHCA today:
1) Americans may choose not to carry health insurance. For those choosing not to carry health insurance, they will not be able to deduct as many healthcare expenses from taxes, and a 30% premium penalty will be imposed upon them if they decide to re-enter the health insurance market. It is unclear whether this penalty would be imposed for only the first month, year, or more.
2) Those with pre-existing conditions will be placed in a separate “pool” of insurance customers. States will be able to choose how to define and cover pre-existing conditions for their residents. The federal government will set aside an extra $8 billion on top of the originally proposed $130 billion to help “states repair their health markets damaged by Obamacare” (HouseGOP, 2017). This $8 billion is specifically intended to keep premiums affordable for high-risk patients.
3) Tax credits will be provided for people based on age instead of income. Employers will not be required to provide health coverage for employees. Health Savings Accounts will be incentivized by tax cuts and higher contribution limits (HouseGOP, 2017).
4) Medicaid expansion will be rolled back, meaning fewer people will qualify for Medicaid coverage. This also means that states will no longer be incentivized to spend more and more on Medicaid.
5) The AHCA will apply to everyone…including Congress and government officials and staff. (HouseGOP, 2017).
As of May 25, 2017, the CBO (Congressional Budget Office) has scored the AHCA and concluded that it will cover fewer people, but will reduce premiums, and will not add to the deficit. Part of the reason that fewer people are covered is the lack of a mandate, which allows people to choose NOT to carry healthcare coverage. We have been told that Health and Human Services Secretary, Tom Price, has the power to allow buying insurance across state lines, and purchasing medications from other countries. (Health Network Group, 2017) BOTH of these ideas, if born into reality, will greatly reduce the costs associated with taking care of those we love most, by adding competition to the presently monopolized market.
Regardless of where your opinion lies pertaining to Obamacare, it is destroying itself. People often say that Europe and Canada have wonderful healthcare that is FREE for all, and we should too. What they do not tell you is that people pay exorbitant income taxes in those countries and have few choices. Our country is not set up like European countries or Canada, and what may work there may not work well here. Americans are used to having choices and weighing the risks between paying more for something of higher quality or paying less for something that may be okay in the short run. Aetna, United Health, Humana, and Blue Cross Blue Shield are pulling out of the markets in places around the country…leaving some states with no choice at all. CNBC reported in August of 2016, that “one-third of US [wouldn’t] have a choice between Obamacare plans in 2017….with 55% [having] two or fewer insurers to choose from” (Mangan, 2016). Some regions of counties were correctly predicted to have no choice…no plan available to them at all (Mangan, 2016).
Some have accused Trump of racism, lack of compassion, or incompetence because he wants to repeal Obamacare. I do not agree. Repealing Obamacare is just smart. Period. Obama tried. His plan failed. If nothing is done about the system, few of us will have healthcare at all, as providers retreat from the unsustainable marketplace (Restrepo, 2016). It has nothing to do with the color of Obama’s skin and little to do with his politics. It is simple economics. Economics is no respecter of politics, and the ACA simply does not pass economic muster.
If the AHCA is signed into law, my family may be in the “not covered” group because I trust my ability to save money for future medical bills more than I trust the government’s ability to take care of me. Perhaps you disagree and would rather pay a premium for health coverage. Someone else may choose to have a very limited insurance policy with a low premium and high deductible. That is the beauty of America that I hope to see restored…to have choices…so we all win!
Gaba, C. (2016, May 13). Tracking Enrollments for the Affordable Care Act. Retrieved from ACASignups.net: http://acasignups.net/16/05/24/presenting-aca-signups-2017-requested-rate-hike-challenge
Gabba, C. (2017, 5 5). Tracking Enrollments for the Affordable Care Act 2018. Retrieved from ACASignups.net: http://acasignups.net/2018-rate-hikes
Health Network Group. (2017). Obamacare vs Trumpcare. Retrieved from Obamacare.net: https://obamacare.net/obamacare-vs-trumpcare/
Health Network Group. (2017, 5 5). Trumpcare vs Obamacare. Retrieved from Trumpcare.com: https://trumpcare.com/trumpcare-vs-obamacare/
HouseGOP. (2017, May 5). The American Health Care Act. Retrieved from housegop.gov: https://housegop.leadpages.co/healthcare/
Mangan, D. (2016, August 19). Health Insurance: One-THird of US won’t have a choice between Obamacare plans in 2017. Retrieved from CNBC: http://www.cnbc.com/2016/08/19/one-third-of-us-wont-have-choice-between-obamacare-plans-in-2017.html
Restrepo, K. (2016, September 8). Opinion: Daily Journal: Most in N.C. Will have one Obamacare option in 2017. Retrieved from Carolina Journal: https://www.carolinajournal.com/opinion-article/most-in-n-c-will-have-one-obamacare-option-in-2017/