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The folks who complain about the ACA are most often young men who simply donât understand how health insurance worked before. So hereâs a little background for you, fellas.
Before, insurance companies could insure who they wanted and charge what they wanted with almost no rules.
Before, insurance companies could insure who they wanted and charge what they wanted with almost no rules.
They regularly denied coverage to people deemed to have pre-existing conditions, some of which were serious conditions, but many of which were not. It was totally at their discretion. Nearly anyone could be deemed to have pre-existing conditions and denied.
If they did agree to insure you, the pricing was based more on your likelihood to pay than on actual risk. Young men were generally offered cheap plans because weâve known for decades that young men rarely get medical care and wonât pay for it. Theyâd rather get your $150/mo...
...than nothing, especially knowing you were almost certainly not even going to go to the doctor.
Meanwhile, they charged older and sicker patients as much as they wanted to, knowing those patients had no choice but to find a way to pay.
It was more game theory than economics.
Meanwhile, they charged older and sicker patients as much as they wanted to, knowing those patients had no choice but to find a way to pay.
It was more game theory than economics.
So with all the folks who had this mythical cheap insurance before, they were gambling that you wouldnât go to the doctor, but then if you somehow did rack up a bunch of unexpected expenses, they would simply cap your coverage or kick you off. They had all the power.
Other fun facts about insurance pre-ACA: there were no rules about what an insurance plan had to cover, so you could technically be insured, but they could deny virtually everything. There were no lifetime limits or even annual limits on how much you could be made to pay.
And there werenât strict caps on how much profit insurance companies could make.
The ACA fixed all of those things, and made pricing more fair to everyone.
But if you paid the least before, that looks unfair. Itâs not, itâs just that you saw very little of the big picture.
The ACA fixed all of those things, and made pricing more fair to everyone.
But if you paid the least before, that looks unfair. Itâs not, itâs just that you saw very little of the big picture.
We had 20 million more uninsured people before ACA, and saying that we donât want to pay for them deeply misunderstands economics. People still need emergency care, and itâs generally more expensive if they didnât stay on top of their preventive care. We are paying for that.
The rates for uninsured people are astronomical for even simple services, and if you canât afford insurance, you probably also canât afford your medical bills. So those costs get shifted to all the rest of us.
We are already paying.
We are already paying.
All economists who study this say costs are lower for everyone if everyone is insured, and costs are higher for everyone the more uninsured people we have.
Of course, costs would be lower still if we didnât have to pay for insurance co. profits and scores of âmedical billers.â
Of course, costs would be lower still if we didnât have to pay for insurance co. profits and scores of âmedical billers.â
But doing the latter would go well beyond the ACA, and thatâs not what weâre talking about now.
Going backwards and eliminating the ACA would kick tens of millions of people off health insurance, with disastrous effect, and cost us all more. Itâs pretty simple.
Going backwards and eliminating the ACA would kick tens of millions of people off health insurance, with disastrous effect, and cost us all more. Itâs pretty simple.
I also didnât mention waiting periods. If they had no choice but to insure you, mainly if you got your insurance through work, they could say that you werenât eligible for any coverage on a pre-existing condition until youâd been on the plan for a year or more.
Take my asthma, for example. When I was a kid, my dad was disabled, so I got my health insurance through my mom, who changed jobs often. So I was often in the waiting period gap, and during that time, I couldnât get care for my asthma. No coverage for inhalers or tests.
Asthma care is not something you can put off. If you need an inhaler, you need an inhaler. Luckily, I never had any critical emergencies when it wasnât covered, but I easily couldâve ended up at the emergency room because insurance wouldnât cover my basic preventive care.
Sub in anything else you want for that. Heart disease. Diabetes. A cancer recurrence. Post-COVID syndrome. Denying people care on pre-existing conditions, even for âonlyâ a year, could kill them or at the very least make their care down the road so much more expensive.
And again, we all pay for that, whether itâs through higher taxes or higher healthcare costs or higher insurance premiums. Thereâs no skipping out on that stuff. The best, cheapest thing we can do is always cover preventive care, always.
Does the system still need improvement? Absolutely. The ACA has never been allowed to function fully as intended. But the idea that we should take away patient protections and limitations on insurance profits is based on misremembering the past and misunderstanding economics.
