The Problem: People Get Sick
When President-elect Trump and his buddies in Congress repeal Obamacare, they’ll have to figure out what to do with all the sick people that the health insurers don’t want to deal with.
Remember, the big problem before Obamacare was that health insurers refused to cover sick people. In fact, most of us know someone who was declined health insurance because of an existing health problem.
Obamacare’s Three-Part Solution
Obamacare solved the problem with a three-part solution:
- Banning pre-existing condition exclusions;
- Establishing a mandate that everyone carry health insurance and;
- Offering premium subsidies to make health insurance more affordable.
As we explained in our blog An Uneven Playing Field: Health StatusDiscrimination, the individual mandate and the pre-existing condition ban work together to avoid “adverse selection” and keep the health insurance companies making money. The premium subsidies make health insurance more affordable (at least at the front-end), increasing the chances that healthy people will buy policies.
These three solutions combined were necessary to keep the private health insurance industry “in the game.”
Is private health insurance really necessary? Nope.
If we had universal, public health insurance like Medicare for All, we wouldn’t need to placate the corporate interests in health care.
But implicit to “Obamacare” is keeping those interests in the catbird seat. This is what’s known as a “neoliberal” solution, or what we at HEAL California call “A Deal With the Devil.”
It is the height of irony that our current opportunity to modify Obamacare will result in destroying what is good in it, only to double-down on what is horrible in it.
What’s the GOP alternative?
The GOP plan is to go back to the bad old days.
Before Obamacare, people with pre-existing conditions didn’t have a lot of options. One option was to get a job with health insurance benefits (assuming they were healthy enough to work). Or they could marry somebody who had employer provided insurance.
Another option was to become destitute, which would then qualify them for Medicaid (Medi-Cal in California).
And their third option was to try to get into their state’s high-risk pool, if there was one. Not every state maintained a pool. In fact, only 37 states did. And every pool was different, depending on the state. Different as they were, they provided some coverage to people who had been denied health insurance because of a pre-existing condition.
But they all had something in common. They all limited access to care.
Designed to prevent getting care
Yes, you read that right! Instead of making it easier for sick people to get the care they needed, high-risk pools made it more difficult. The programs were designed to limit access to health care.
How? With coverage waiting periods, limited lifetime benefits and very high premiums.
In many cases, people had to be uninsured for six months to even qualify. People who are sick with chronic illnesses can ill-afford to skip care for six months, but that’s what they had to do in many cases.
Fact: State-based high-risk pools don’t work
The facts about state-based high-risk pools and how they didn’t work are well documented. Check out Kaiser Family Foundation’s thorough review and analysis of the history of high-risk pools, published in August 2016.
Better yet, check out what Terri Carlson has to say about high-risk pools, from her perspective as a member of the pre-existing condition community. Here’s Video 3, on High-Risk Pools, in her latest “Terri Talks Healthcare” Series.
If you’re still not convinced, check out this article, “Why Ryan’s high-risk insurance pools are a risky business” (The Hill, May 2016). The author, Carolyn Long Engelhard, Director of the Health Policy Program at the University of Virginia School of Medicine, concludes:
The ACA has its problems, and the hyper-partisanship surrounding it is great fodder going into November’s presidential election. However, since the ACA was set up in part to address the problems brought on by risk-rating individuals and the inadequacies of state-based high-risk pools, having the Republican leadership embrace the entity as a new strategy to ameliorate the failings of ObamaCare seems risky at best and quite ironic.
Fact: A national high-risk pool won’t work either
Don’t even go there! Studies show a national high-risk pool won’t work either. Jean P. Hall, Associate Research Professor at the University of Kansas, in her issue brief “Why a National High-Risk Insurance is Not a Workable Alternative to the Marketplace” (The Commonwealth Fund, December, 2014), analyzes this issue in great detail.
Her conclusion? In terms of both cost and coverage, we’re better off with very large risk pools that include everybody.
Bottom line, high-risk pools are no answer
Going back to high-risk pools is simply no answer to our problems. And Health Status Discrimination is just plain mean. So what should we do instead?
What IS the answer?
Clearly, it’s Improved, Expanded Medicare for All! It’s the very definition of a very large risk pool: everybody in, nobody out! And by getting those health insurance companies out of the deal, we can choose the doctors we want and dump the high deductibles and other costs.
If you want California to lead the nation with our own Medicare for All system, take action! Join us on Twitter and Facebook, and
Sign our Open Letter to Governor Brown and Our Legislative Leaders!
Dear Governor Brown, Senate President Pro Tem DeLeón and Assembly Speaker Rendon:
California families depend on Medicare, Medi-Cal and Obamacare for our very lives.
Protect these programs, but more.
Give us healthcare that covers everybody for everything for life!