Why ACA may be a negative in 2016


Dr. Hugo Z. Hackenbush discovers that thanks to anti-trust exemptions (and hostage capitalism), his hospital can charge $99K for a COPD patient who would have to pay only $7K for the same treatment across the river in the Bronx. from Day at the Races.

I’ve been trying to explain to my liberal, pro-Hillary friends that championing the ACA (also ‘Obamacare’) is not a winning strategy for the Democrats. My experience with the ‘reforms’ has been that employer-provided insurance now comes with far bigger deductibles and less coverage, at least up front–you have to pay down a lot of co-pays and deductibles before you get to the point where the insurance company foots even part of the bill. And my friend Jerry Ashton’s ‘RIP MEDICAL DEBT‘ website is still quite busy. Remember, the insurance co’s are not the only people with their hands out. The whole ‘healthcare network’ racket means that if you have a medical emergency and the ambulance drops you at the wrong hospital, you’re probably on the hook to pay that bill out of pocket (and at a RETAIL rate, not the steeply discounted rate the ‘preferred insurer’ gets). I still have friends telling horror stories about coverage not provided over bureaucratic pissing wars. And while getting insurance through one’s employer is easier (at least in theory), it also saves you the prospect of actually doing the numbers and realizing what it costs you to be insured in the only industrialized country in the world where you can go bankrupt from medical costs, even if you’re insured.

Hence, this. It was put up on Mister Facebook by an acquaintance named Craig Spector, a writer and novelist whose work garners paychecks (though as those of us in the writing biz can attest, not necessarily BIG paychecks).  He’s staring down the ACA’s fines, now upped in dramatic fashion this year, for people who don’t have insurance. When you file your taxes, you’ll get a big extra hit if you don’t have insurance (which, Obama’s promises notwithstanding, is NOT THE SAME AS MEDICAL CARE. You can use insurance to pay for medical care–SOMETIMES).

So, today is the deadline for signing up for the ACA, aka Obamacare. Yesterday I went to Healthcare.gov and went through the application process: the basic broadstrokes outcome is as follows.

Caveat: when the fight was on to pass Obamacare, I was in favor of it, in theory, because something needs to be done. And as you peruse the results, bear in mind that the GOP solution is to simply repeal it and replace it with… absolutely nothing. Because this is America dammit, home of the best damned health care system in the whoooole wide world.

At my income level, I qualify for no rebates or tax credits to offset my premiums, so whatever I would get would be paid at full market price. The plans available to me ranged from catastrophic (the lowest, covering less than 60% of average costs for the year), through bronze (60%), silver (70%), gold (80%), and platinum (the highest, covering 90%.) There was one plan available at the catastrophic level; there were zero plans available at the platinum level.

At the @$540/month Catastrophic level, my annual premiums would be @$6,480. My annual deductible would be @$6,800… with an out of pocket maximum would @$6,800. So, I would have to spend @$13,280 before my shiny new health insurance would pay for the first >$0.60 of actual health care.

At the Bronze level, the plans range from $584 to $691/mo., with deductible of $5,350 and a max out of pocket of $6,665… or $12,358 to $13,642 before I would receive the first $0.60 of actual health care.

At the Silver level, the plans range from $704 to $777/mo., with a deductible of $2,621 and a max out of pocket of $6,850… or $11,069 to $12,722 before I would receive the first $0.70 of actual health care.

At the Gold level, the plans range from $871 to $963/mo., with a deductible of $962 and a max out of pocket of $5,925… or $11,414 to $13,481 before I would receive the first $0.80 of actual health care.

Quite the bargain, eh?

Something that gets lost in the hyperbole in this, the best damned health care system in the whoooole wide world, is that there is a difference between health insurance and health care. All of the plans available would send me a shiny brochure telling me all of the care my premiums would theoretically be buying… although from my previous experiences in purchasing pre-Obamacare personal health insurance, every single time I tried to use it, the claim would be automatically denied for the first year (to safeguard against possible fraud, doncha know.) But I would have that shiny brochure.

The money I paid would be real. The care promised would not be, in that I would never actually receive anything.

In my own personal case, there is a ray of sunshine, in that I qualified for VA Medicaid. Great news, right? Oh wait. Virginia did not accept the Federal Medicaid expansion (thank you, GOP-controlled VA legislature!) so the only care I would be eligible would be for “family planning.” Which means, all I could get for it is condoms, or a vasectomy. At one point I asked, could I at least get Viagra? Nooooo, don’t be silly. But at least I have my exemption number, which means I won’t have to pay the minimum $695 fine when I do my 2015 taxes. Woo hoo.

Lest all my Republican or Libertarian friends chortle too much over this, let me repeat: the solution being offered by the GOP is, absolutely nothing. Because this America, dammit, home of the best damned health care system in the whoooole wide world. Free market, bitches! Suck on it!

I’m a self employed independent contractor, and I work over 40 hours a week. But if I get sick or need a doctor, my choices are 1) pay out of pocket for everything, 2) go to an emergency room, 3) go to a free clinic, or 4) fuck off and die already, loser.

All of this is brought to you by legislators who all — every single one — have not just health insurance, but actual health care, and all of whom could afford these premiums, although they are going to vote themselves another pay raise anyway. Just cuz.

A pox on all their houses.

So this is where we are and Craig put out the information better than I ever could. I haven’t done the same exercise here in NY, but the one variable is the VA care/Medicaid option, which is meaningless to me. And medical care is generally more expensive in NY state than almost anyplace else in the US. 

Back to Hillary. She has been trying to use the issue of support for the ACA as a cudgel to beat up Bernie Sanders, claiming that Sanders wants us to throw out Obamacare and start from scratch. In Sunday’s debate, Hillary mounted an unapologetic defense of the ACA and derided Sanders’ call for replacing it with Medicare for all. Hillary’s defense of ACA is probably working with the people who already supported Clinton, but I don’t think it will work across the US. There are lots of people like me who think that in some fundamental ways, the ACA made things worse. Will we vote for the GOP if Hillary wins? Probably not. But I add this position to a number of others that make it possible that Hillary won’t have a chance to run against Trump or Cruz. And even if it comes down to Clinton Vs. Trump, will the GOP try to run against the ACA? They’ve been doing it all along, but for silly reasons–birth control coverage, ‘death panels’, ‘government run health insurance’, etc. If it comes down to Hillary, she will be very lucky if the GOP never tackles the real defects in ACA.

Too much of the 2016 polling has been driven by election-year horse-race coverage. And Sanders is not getting heard, even though current polling calls the Hillary vs Bernie struggle a nailbiter. A win for Sanders in Iowa or New Hampshire changes the game. And at that point the Democratic Faithful are going to vote on the future for the ACA. I don’t think it will be pretty. 

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