Healthcare Heaven? Or Hell?
I admit that I love sci-fi. And when sci-fi comes true, it’s so cool, right? Well, sometimes, but not always!
Especially not when the movie is Elysium (2013) starring Matt Damon and Jodie Foster. It’s about a future where the 1% live on a luxury satellite with unimaginably advanced healthcare while the rest of us live on a ruined Earth, dying of deliberately untreated infections and diseases.
All too real
When I saw the movie, I was just struck. Not because it was science fiction, but because it was actually happening. Elysium depicted the healthcare reality for millions of Americans before Obamacare.
Up until 2014, when the Obamacare health insurance exchanges were launched, health insurance companies used a variety of strategies to avoid losing money from insuring sick people.
Mainly, they refused to insure them. People with pre-existing conditions might be offered insurance policies that excluded coverage for the very health conditions they needed coverage for! Or they might be denied coverage completely.
No Money, No Care
Millions of sick Americans who could not afford to pay out of pocket for their health care did not get the care they needed.
The unhealthy among us got the worst care and paid the highest price for it, including with their very lives. Yes, people died.
Obamacare & the Individual Mandate
Obamacare banned pre-existing condition exclusions, but at a price. Health insurers refused to go along with the ban unless the deal included an “individual mandate” that everybody be insured. Why? It has to do with the mathematics of risk.
According to the American Academy of Actuaries:
The pooling of risk is fundamental to insurance. Large pools of similar risks exhibit stable and measurable characteristics that enable actuaries to estimate future costs with an acceptable degree of accuracy…For a risk pool to remain viable, it must be of sufficient size and comprised of a broad cross section of risks. . . .An individual mandate can reduce adverse selection by increasing participation.
Stable Risk Pools = Predictable Costs
Health insurance works by using risk pools to spread the risk of needing care among a large number of people. The larger the risk pool, the better.
Unless everybody – whether healthy and unhealthy – is required to buy health insurance, then only unhealthy people will buy it. During any given year, unhealthy people are more at risk of needing health care, and healthy people are less at risk. If the risk pool includes a disproportionate share of unhealthy people, the private health insurers can’t make enough money to pay their CEOs $20 million a year, their shareholders dividends, and so forth.
The Return of Health Status Discrimination
Now, with the new administration, Congress is talking about repealing Obamacare. Specifically, they’d like to trash the individual mandate. If they do, health insurers are going to back out of the ban on medical underwriting. And when that happens, people with pre-existing conditions are going to be hit, but hard.
Want to know how hard? Check out Terri Carlson’s latest video on Health Status Discrimination to get the facts based on her personal experience.
If you’re healthy, it’s easy to think, “Well, it won’t affect me! So what.” But remember, being healthy is a temporary state. At any moment, you could be in an accident, develop a disease or suffer a mental illness. Then what will you do?
How many of us will be affected?
Kaiser Family Foundation offers a conservative estimate of roughly 52 million people, or 27% of the American population, depending on how you define “declinable pre-existing condition.” Other estimates indicate almost double that – or 50% of us – could face coverage denials. (The 50% figure is based on the definitions of declinable medical conditions commonly used by health insurance companies before Obamacare, natch!)
Which of us may lose coverage?
Anyone who has an illness such as cancer, heart disease, diabetes, genetic disease, asthma and so forth, or who has recovered from such illnesses, is at risk. Check out our recent blog Back to the Bad Old Days for specifics on medically declinable conditions, medications and occupations.
What will we do then?
Speaker Paul Ryan and the Congress want to go back to using high-risk pools. High-risk pools! They’re awful! We’ll talk more about them in our next blog, but one thing we know for sure is they offer limited coverage for a very high price. In other words, high-risk pools are no answer.
Instead we need to preserve the gains of Obamacare, and build on them!
We Need Improved, Expanded Medicare for All!
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!