10 reasons not to appeal Obamacare
I originally posted this to my Facebook account, because a lot of the people I went to high school with are Trump voters and don’t know anything about the ACA beyond, “Premiums up, Obummercare bad!” I thought I might as well post it here as well, even though I know I’m probably preaching to the choir.
This post turned out to be longer than I thought it would be, and unfortunately I think the people who need to read it most probably won't finish it, but I'm putting the information out there anyway. My hope is that people will read it and get a better understanding about the Affordable Care Act (a.k.a. Obamacare) and how it affects them and the people they love, and perhaps get a few more people in the US to call their senators and House reps about opposing repeal. Here are some of the major provisions of the ACA and why they're important.
- Coverage for people with pre-existing conditions: Everyone knows about this one, and this alone should be a reason to keep the law in place. As a diabetic who was, until just about this time last year, self-employed for 20 years and forced to buy health insurance on the private market, I can tell you this is, in the words of Joe Biden, a big f*cking deal.
- Coverage for dependents until the age of 26: Everyone knows about this one, too. Before the ACA, plans could kick your kids off at the age of 18. I have a 21-year-old, and I worry constantly about what the economy is going to be like at the end of the Trump years (my prediction: it's going to be very, very bad) and whether he's going to be able to find a job in that environment or not. With the ACA, I know he will at least have health insurance if nothing else.
Those are the no-brainers. Everyone understands those. Here are some other benefits of the law you might not be aware of, but which are also very important.
- Essential health services: Every health insurance plan is now required to cover a set of 10 categories of health services. These include inpatient and outpatient hospital care, emergency services, hospitalization, prescription drug coverage, pregnancy and childbirth, mental health and substance abuse disorders, rehabilitation services and devices, lab services, preventive and wellness services, and pediatric oral and vision care. Plans may cover more if they wish, but they MUST include at least these basic services. Co-pays and deductibles may still be involved, except for preventive and wellness services (see #10 below).
Before the ACA, plans didn't have to cover all of these services, and most did not. Try finding a plan that had mental health or pregnancy coverage, for example. And many plans were known as "junk plans," which were very low cost plans but for a good reason: they didn't actually cover anything. They might cover your doctor's visit - with a $75 co-pay - but if you actually got sick or needed a blood test or an x-ray, forget it. It was 100% out of pocket.
This is one reason I find it hard to empathize with people who complain about how high the premiums and deductibles are under the ACA. The plan you were paying for before was probably a piece of crap, and what's worse, you wouldn't have even known that until you needed it the most.
- Ban on rescission: Before the ACA, insurance companies would, pretty routinely, cancel policies when people got sick. This is called rescission, and basically it meant you could pay into a policy for years and years, and then when you got into a car accident or found out you had cancer, it would disappear.
Here's the way it worked. Before the ACA, when I would shop for insurance on the private market, the insurance application required me to list every doctor's visit, illness, procedure, and prescription drug (including the name of the drug and the dose) for the previous five years. Think about that. I'm diabetic, so I see a lot of doctors on a regular basis. I have records of most of those visits, so maybe that's not a problem. However, I see doctors for reasons unrelated to my diabetes, too. I've had ear infections, sinus infections, skin problems, eye exams, pap smears and mammograms, dental work, routine physicals, a minor outpatient surgical procedure for an infected cyst, and I'm sure other medical stuff I've forgotten about… and that's the point. How on earth am I supposed to remember EVERY contact I've had with the medical profession for the previous FIVE YEARS? How am I supposed to remember every drug I've been prescribed, the EXACT dose, and how long I took it? That's a ridiculously high burden, IMO
But okay, let's say hypothetically I get through the process and my health insurance is approved. I pay into the policy for a few years, and then it turns out I develop some new health condition that needs care. That's when the insurance company would start going through my past medical records and comparing them to my application. "Hey!" they might say. "You never told us you were on erythromycin for 10 days in 2008. You lied to us when you submitted this application by not telling us that. We're cancelling your policy."
Under the ACA, insurance companies can no longer cut off your policy when you need it except in cases of non-payment or demonstrable, intentional fraud (i.e., not just forgetting to mention you had treatment for acne 4 years ago). Some states had already banned rescission prior to the implementation of the ACA, but not all. Now, it's illegal across the country.
- No more lifetime limits on coverage: Prior to the ACA, many insurance companies would put caps on how much they would pay for your healthcare costs for your entire life. The cap was often around $1 million. Which, okay, sounds like a lot, but it's not a hard figure to reach if you're talking about cancer or a life-long condition like hemophilia or any number of other conditions that are very costly and/or take a long time to treat. Not to mention, kids might hit that cap when they're 8 years old, and then what? And remember, you now have a pre-existing condition, which without the ACA in place means you are going to have a hard time finding another plan to cover you.
The ACA banned lifetime coverage limits for kids in 2010 and for adults in 2014. This is something that affects all of us, whether we have private insurance or employer-provided insurance.
- The 80/20 rule: This is an ACA mandate that requires insurance companies to spend at least 80% of the money they take in on premiums on your health care and on quality improvement activities instead of overhead and marketing. Insurance companies selling to large groups (50+ employees) must spend at least 85% of premium dollars on healthcare and QI. If your insurance company doesn’t meet these requirements, you get a rebate on your premiums.
Again, this impacts all of us, regardless of the source of your insurance.
- Women can't be charged higher rates than men just because we are women: A lot of folks try to justify this by saying women should pay higher rates because of pregnancy, but before the ACA only 12% of insurance policies even covered maternity services and we were still paying higher rates, so that argument doesn't hold water. And I get that men might be pissed off that their rates rose as a result of this provision, but that wouldn't have even been an issue if the discrimination never existed in the first place.
- Contraceptive coverage: This one has been controversial, I know. A few high-profile SCOTUS cases have watered it down a bit, but I just want to say this: This has never been about "free" birth control. It is, and always has been, about the plans that women PAY for providing them with a legal prescription drug.
This also affects all of us, whether we are women using birth control or not. Think about the impact of pregnancy (wanted or otherwise) on the woman, her family, and society as a whole, and you can see why.
- Closing the Medicare "donut hole": Medicare currently has a coverage gap called the "donut hole." What this means is seniors get coverage for their prescription drugs up to a certain limit every year. In 2016, it was $3,310. Once they reached $3,310, they had to pay out of pocket for ALL of their prescriptions until they reached $4,850, and then Medicare starts picking up their costs again. In 2012, the donut hole started at $2,930 and ended at $4,700. That means between 2012 and 2016, the hole closed by $230. The gap is supposed to continue closing through 2020 under the ACA. There are also provisions in the ACA for seniors to get discounts on both generic and branded drugs, and these discounts will continue to get larger until 2020, as well.
Are you a senior citizen? Are your parents or loved ones senior citizens? Are you/they living on fixed incomes? If so, this is important.
- Routine preventive care is free: This includes too many services to list them all here. You can check out this page for more information.
It goes without saying this is also important to all of us. Again, however, "free" is a misnomer. You're paying for your insurance policy and these are covered services. Nothing here is actually free.
All of this, IMO, is pretty good stuff, and I don't want to lose it. And this is only the tip of the iceberg. I didn't even get into stuff like ending job lock (i.e., being forced to stay in a job rather than changing jobs or starting your own business because you don't want to lose your health insurance), or the decrease in the rate of growth of healthcare costs, or the decrease in the federal deficit to which the ACA will lead. I didn't get into the individual mandate and the key, key, vitally important role it plays (OMG it's SO IMPORTANT). I didn't get into the drop in the uninsured rate since the ACA was implemented. And I didn't get into the fact that the GOP "repeal and replace" thing is ridiculous and we will more than likely never see a real replacement plan that is as effective as the ACA (that's a big enough subject to warrant its own post someday). There's no way to get into the full complexity of the ACA or the health insurance industry in one post like this, and in any case I am not an expert on these matters, I'm just someone who's been trying to pay attention.
I just want people to know there's really quite a lot at stake here. And it goes without saying that the Democrats have done a terrible, terrible job at getting the message out.
And yeah, I know, premiums and deductibles have gone up, and that really sucks. Believe me, I feel that pain as much as you do. But now we are actually guaranteed to get something for our premiums (see #3 above) and besides, there is one overarching principle you must keep in mind:
INSURANCE COMPANIES DON'T EXIST TO KEEP YOU HEALTHY. THEY EXIST TO MAKE A PROFIT.
This is why so many of us are screaming about the importance of a single payer system. Healthcare is a basic human right, but insurance companies look for any and all ways to charge you as much as they possibly can while providing the fewest services they possibly can. They were going to raise your premiums and deductibles anyway, folks. That is 100% guaranteed. The ACA does not tell insurance companies how much they can charge for their services. In fact, it has provisions in place that require insurance companies to justify premium increases of more than 10%. If your insurance premiums are too high, that is on insurance company greed, NOT the ACA.
If the law is repealed, we may see a short-term decrease in insurance premiums (though we may not, because again, insurance companies are greedy). But before you celebrate and point gleefully at the ACA as the cause of all your woes, be sure to check your coverage carefully. Compare it to the plan you had under the ACA and see if you really, truly are getting the same level of coverage for less money. Make sure they aren't pulling a bait and switch and plan on phasing out pieces of your coverage over time. I feel pretty confident in saying:
- Your coverage will be inferior (if not at first then over time), and
- Your premium and deductible will go up the following year. And the one following that. And the one following that. Ad infinitum. Because that's how insurance companies roll.
Please call your senators and House reps.