Paul Krugman, NYT
Are you better off than you would have been 14 years ago? If you’re one of the millions of Americans who have a preexisting medical condition and don’t have a job that comes with health benefits, the answer is, overwhelmingly, yes.
Why? Because before the Affordable Care Act, a.k.a. Obamacare — signed into law on March 23, 2010, although many of its provisions didn’t kick in until 2014 — you probably wouldn’t have been able to get health insurance. Today you can, thanks to provisions in the law that prevent insurers from discriminating based on medical history and that subsidize insurance premiums for many Americans. (These subsidies also provide healthy people with an incentive to purchase insurance, improving the risk pool.) And President Biden strengthened the program, notably by extending provisions eliminating the “cliff” that cut off subsides for many middle-class Americans.
But in the near future, you may well lose that hard-won access. In 2017, Donald Trump and Republicans in Congress tried to eviscerate the A.C.A. and almost succeeded in passing a bill that the Congressional Budget Office estimated would have left 22 million more Americans uninsured by 2026. There’s every reason to believe that if the G.O.P. wins control of Congress and the White House in November, it will once again try to bring back the bad old days of health coverage. And it will probably succeed, since it failed in 2017 only thanks to a principled stand by John McCain — something unlikely to happen in today’s Republican Party, where slavish obedience to Trump has become almost universal.
For a piece of legislation written to create a “free market solution”tm by a Republican think tank, they sure do love attacking it.
I remember “pre-existing condition” exclusions. Insurance companies hired teams of investigators who would comb through the medical histories of patients who made expensive claims (like chemotherapy). They would find something, anything, in that person’s medical history that they could claim was “pre-existing”, from some time prior to being covered, and deny the claim. Often this was done in full knowledge that the denial could be appealed. But they also had statistics that if that patient died from their disease the family was unlikely to pursue an appeal.
Having a gap of any length of time in your insurance history could be devastating. I had to buy personal insurance once during this time (circa 2001). I was young with no medical conditions and in good health, and it was $160 a month with a deductible so high it was basically worthless except for catastrophic emergencies. I was making $8.50 an hour at the time. But it prevented me from having a gap in coverage that could be used later, perhaps many years later, to deny claims.
Of course the only solution that’s politically viable is apparently a giant subsidy to capital. Same with Section 8. Same with education loans. We’re incapable of anything else it seems.
Insurance companies still do many versions of this with a byzantine coding system, complex “out of network” exclusions, etc. Anything to deny a claim. It’s a capitalist version of a “work-to-rule” slowdown, where they can make new rules. Since it’s your health they can afford to wait forever. The asymmetry favors them. It’s about as close as you can get to directly chucking human bodies into a furnace to power a money machine and still maintain a veil of propriety. True evil. If there was any justice in the world, the food that these executives bought would turn to ash in the mouths of their children.
Insurance companies still do many versions of this with a byzantine coding system, complex “out of network” exclusions, etc. Anything to deny a claim.
Yep. My criminal insurance company (CIC) marketing docs trumpeted how my ER costs were “fully covered” (which they’re required to be by law, I think). That’s obviously bad for profits, so the solution? Well just interpret any ER line-item (pick some expensive ones) as non-ER, even when they pertain to an ER visit, then charge the whole slew of separate copays/deductibles that go with the new interpretation. Profit! The hospital, which has a contract with the insurer, will cooperate and code all these line-item services with ambiguous language and codes, making them ripe for the picking by the screw-you insurance dweebs.
Oh, I can appeal the insurance decisions? Great. Appeal #1 is decided by the insurance company itself! 100% internal. Appeal #2 is done by a third party company, selected by the insurance company and paid by the insurance company. Think your state insurance commissioner is going to step in when foul play occurs? Think again. If they pay attention to you at all, they’ll claim to have no “authority” to make “medical decisions” about the abuse the insurance companies subject you to, and if they do anything at all, it might be to write a mildly-stern email to the insurance company reminding it of your complaint and their supposed obligations. That’s it, the commissioner’s office is not on “your side” and even if it were to some extent, they’ll claim to be “too overloaded” to do anything, anything like actually regulate the insurance companies, on your behalf or on behalf of the other millions of insurance customers.
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