Tuesday, September 24, 2013


I have, at various times, employed people other than myself.  Because we have a stupidly inefficient way of paying for health care in this country--principally as an employee benefit--and because it has been virtually impossible for anyone other than young, healthy people to buy decent health insurance on the open market, I have always felt obligated to provide health insurance to my employees, although it was not always possible to do so.

In later years, we had a very generous health insurance plan (still do, in fact) that had low co-payments and a low deductible and paid 100% in-network after the deductible was met.  It was expensive, but because we were eligible to be members of a health benefit trust set up by the bar association, it was less money than it might have been.

But I always thought it was stupid to tie health insurance to your job.  That fact of American life makes indentured servants out of people who can't afford to give up their health coverage by quitting their jobs.

This has been in the news lately because the dawn of ObamaCare is on us.  Starting October 1, you will begin to be able to shop for health insurance through public exchanges for coverage that begins at the beginning of next year.  A couple of days ago, the Arkansas exchange released rate tables.  We don't know precisely what these plans will cover yet--they will all provide 10 types of core coverage, but the details haven't been released yet.  The rates depend on age and tobacco status alone.  Applicants cannot be turned down for pre-existing conditions.

Currently, I write (or, rather, the business writes) a check for a bit more than $1,000 a month for coverage for Michelle and me.  According to the rate tables I reviewed, the most expensive plan available on the exchange for our age bracket would save us about $250 a month.  What I don't know is how that plan compares to what we currently buy, but that's before any subsidy that we might be eligible for (and some 85% of participants will be eligible for some subsidy).  If the coverage isn't as good as what we have currently, we can keep what we have.

When the Affordable Care Act was passed in 2009, I was skeptical that it would do much good.  I have long been an advocate for the "public option"--in fact, I was writing about it before anyone on the national scene was doing so--because I recognize that we're probably not quite ready for single-payer (a system like most of the rest of the world has).  In the public option, the government would enter the insurance business as a private market participant.  You could still buy private insurance if you like, but if you chose, you could buy a guaranteed-acceptance plan from the government that looks like Medicare.  In fact, you could call it "Medicare Part E"--E for "everyone's eligible"--and administer it all through the same office.  To me, this would give us the freedom of a market while allowing a very efficient provider who has no profit motive to service the market.

Such a system would be superior, I think, to the ACA, and it would eventually lead to a de facto single-payer system.

But that doesn't mean I don't like the ACA.  In fact, a lot of the reforms the ACA has implemented have come at a tremendously beneficial time.  From my perspective, guaranteed acceptance and the expense ratio rules are true game-changers.  Insurance companies now must spend 80% of their collected premiums on actual care; before that rule, some insurance companies spent as little as 50% of the collected premiums on care.  The lack of a minimum care-spend gave insurance companies a financial incentive to deny as many claims as possible.  And the elimination of pre-existing conditions as a basis for denying coverage will make true mobility in the marketplace possible.

It's become clear that the ACA's reforms are going to have a huge impact.  For that reason, the right wing is in a full-on panic.  One of the Koch brothers' front groups has been desperately running cynical ads on college campuses, urging young people not to sign up for coverage (because it will allow GOVERNMENT into the health care equation).  One ad shows a guy in a creepy Uncle Sam costume--think the King from the old Burger King ads--speculum in hand, about to do a pelvic exam on a twenty-something woman.  Another shows the same character pulling on a glove from the "ObamaCare prostate exam."

I'm surprised that even the Koch brothers think kids are that stupid.  The government's involvement in health care as a result of the ACA is mostly about (a) subsidizing private insurance premiums, (b) requiring that everyone has health insurance, and (c) subjecting private health insurers to rules that make coverage more available.  It's true that more people will be eligible for Medicaid, of course.  But Uncle Sam will not be doing anyone's pelvic exam, and the government certainly won't be making any decisions about them other than to make sure that they're available.

The Kochs, and Republicans generally, are desperate to make ObamaCare fail, because they know that if it succeeds, they're done.  So their strategy has to involve keeping young, healthy people out of the insurance pool, in order to make insurance more expensive all around.  That is, unless they can somehow repeal the ACA.

Even more cynically, the Republicans are trying either to shut down the government by not passing appropriations bills to keep the government running after October 1, or to make the U.S. default on its debt by refusing to raise the debt limit when it's reached sometime after that.  The ransom they're demanding?  Repeal ObamaCare--something the GOP-led House of Representatives has voted to do more than 40 times since it was passed--or, at least, defund it so that it cannot take effect.

They can't pass a jobs bill, or a farm bill, but they can certainly vote to stop abortion and repeal ObamaCare.

By the way, let's don't forget that if you tabulated all of the votes cast in Congressional elections in 2012, citizens pulled the Democratic lever more than 1 million times more than they pulled the Republican lever.  Yet, because of aggressive gerrymandering designed to rob Democratic candidates of votes and the public of a meaningful voice in who represents them, the Republicans hold a slim majority in the House.

It will be interesting to see what happens next.  Part of me is hoping that the GOP does jump off the cliff this time.  Maybe then we can dispense with their nonsense and get down to fixing the actual problems we face.

1 comment:

  1. Our company just released their ACA plans. Living in Texas, of course, I have no state-sponsored Exchange (thank you Rick Perry), and we have the highest percentage of uninsured people in the nation (beating out Arkansas, Louisiana, and Mississippi, think about it).

    My company's health plans are changing dramatically---but the HSA option is, as well. Additionally, because I am over 55, I can transfer money from my 401k to my HSA with no tax or penalty, to increase the balance. Ultimately, it will cost me a bit more, but not much, for roughly the same coverage; I'll also have much more flexibility in choice of medical provider, and the business of having to have a referral from my pcp is gone for good. There are financial incentives to stay in-network, but other than the aforementioned referrals (paper chase), I've had no issue with that; in fact, every physician to whom I've been referred has been top-notch, almost a "luxury" practice. The hospital system is one of the best in Texas. I just have no complaints.

    So, same basic coverage, same administrator, different way of paying roughly the same amount....

    Ain't skeered. Too bad the Repubs are.

    BTW, as I write this, Ted Cruz (R-Texas) is attempting to filibuster tomorrow's Senate vote on the spending bill (this is the same Ted Cruz who excoriated Wendy Davis' epic filibuster in the Texas Senate)--except that by Senate rules, you can't filibuster this type of bill.

    All these people are doing is making Republicans look stupid.