Saturday, March 25, 2017

How eliminating "essential coverage" was going to make health care affordable. Really?

Does it make sense to get emergency care coverage only? As if nothing else can go wrong with your health? The rest of the civilized world has already decided of course not, that

Health Care is a right.

First and foremost, no one decides to not have health insurance unless it's a matter of money. It is essential that health insurance be made more affordable. But the "freedom" to pick and choose is simply an invitation to play Russian roulette with your health.

Moreover, if everyone just picks what they need, it will make those premiums unaffordable, not cheaper, since there will be no pool of currently healthy individuals offsetting insurance outlay for delivering health care to those in need. Even policies which only cover emergency surgery and hospital care will likely be more expensive because they cover catastrophic, high-cost, health events. Not to mention that the first "elective" medical care people forego to save money is their annual check-up, making the need for more expensive care later virtually guaranteed.

We take Trump at his word that he wants affordable health care coverage for everyone. But it's not "coverage" if it doesn't cover everything. Or if it has ridiculously high deductibles. If you buy collision insurance for your car, would you insure only parts of your car? Or be grateful for "access to insurance" which required you pay for the first $30,000 of damage or replacement yourself? Even under the ACA, there are "afforable" plans which have $4,000 and higher annual deductibles per person.

Back to the topic. why is this all so important? According to a February, 2017 survey[1]:

35% of Americans do not know "Obamacare" and the ACA are the same.

An additional 45% of Americans are not aware that "repealing Obamacare" means they lose their ACA insurance.

The Republican intent is to make everything "optional" under the false claim that to do so "offers consumer choice." And if that can't fly with more moderate representatives, perhaps make it a "state's rights" decision — when it is a human right. As we've discussed, pick and choose will make health care more expensive for everyone and, with delays in or inability to afford to address health issues, negatively impact quality of life, even kill people.

What is the essential coverage included in the ACA which the Republicans thought was optional?

  1. Ambulatory patient services  —  outpatient care
  2. Emergency services
  3. Hospitalization  —  inpatient care
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

The logic behind the ACA is simple. If everyone pays for everything, then their premium becomes cheaper for the portion of the health care pot which they use. Everyone pays into coverage for "X", the more everyone doesn't need "X", the cheaper it is premium-wise to cover "X" for everyone. That is how insurance works.

The return of high-risk-pools, limits on life-time coverage, and other roll-backs the Republican bill included would be a disaster for working America. And whatever part of the ACA the "American Health Care Act" did preserve was preserved only by guaranteeing access to high-risk-pools, not affordability.

That the "American Health Care Act" ultimately died on the vine because a faction of the Republicans believed in repeal and no replace, that there is no right whatsoever to health care, should temper the enthusiasm of anyone celebrating that the ACA is still with us. The best and simplest way to remove the financial impact of health care premiums on businesses and individuals is to provide health care for all, not to return to "free market health care plans" which only become affordable when they don't really cover anything, and which force the sick to pay for their medical care out of pocket when devastating illness hits and lifetime coverage runs out.

Most of all, the Republican bill failed to address the elephant in the room:

Why does America spend considerably more on health care, for every man, woman, and child — per capita — than any other country on Earth?

Hint: It's not because we get the best care. Or are the healthiest.


[1]Obamacare And Affordable Care Act Are The Same, But Americans Still Don't Know That, retrieved 23-March-2017.
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