The health insurance post

For years, I avoided comparing our current health insurance premiums with those from the years before the Affordable Care Act went into effect.  I knew I wasn't going to be happy with what I found.

Finally, I dug out some numbers, and indeed I am not very happy with them.  Our premiums in 2018 were double those of 2012.  Our income rose during that time, but it certainly did not double.

Remember, the ACA was passed in early 2010, with most of it not going into effect until 2014--after the 2012 election.  Plus, my husband's employer did what they could with the renewal dates to delay adoption of ACA-compliant plans for their employees until very late in 2014.

This doubling of premiums was not for the same plan or coverage.  In 2012, we had a high-deductible plan (HDHP), which had the nice feature of a very high level of coverage once the high deductible was met, up to the lifetime limit.  There was a health savings account (HSA) offered, which we signed on for and used, and it worked out well for us to have that money saved, because we did meet the deductible that year.

Our plan in 2018 had somewhat lower deductibles, much higher premiums (doubled), along with much higher co-pays and co-insurance.  We had the option of a moderate reduction in premiums by going with a much smaller network of providers, but we ended up not doing that; snafu story omitted. We were a few years older, which added a bit to the cost.  Because of the ACA, there is no lifetime limit, but that requires that at least one of us can stay healthy enough to work and keep paying the premiums through an expensive and possibly medical scenario.

That has left us with theoretically "better" health insurance, but in a much worse position financially for actually using it and getting health care. Let alone all the other things that our very frugal family could be doing with an additional several thousand dollars a year; the ACA carries an enormous opportunity cost for our family.

Of the current crop of presidential candidates, Senators Warren and Gillibrand were in office when the ACA was up for vote, and both of them voted for it.  Neither of them is saying anything about the affordability of health insurance on their campaign website now. I find this a disappointment in the case of Warren, who co-authored The Two-Income Trap, and who knows a bit about the strained finances of American families.  She has chosen to focus her presidential campaign more toward other demographics.

As I have written before, my response to the passage of the ACA was to stop buying paper towels.  I figured that the passage of the ACA had cut ten years from my expected lifespan.  A couple of years ago, from a newspaper article I learned that the number of people buying insurance on the exchanges was about half the number of people who were going without insurance and paying the penalty instead.  (The individual mandate penalty has since been reduced to zero.) With a bit of mental extrapolating, I guessed that you could extend this 1:2 ratio to a 1:2:10 ratio:  for every person benefitted by buying health insurance on an exchange, there were about ten people who wanted to see Obamacare nuked from orbit.

That the Republicans, once they regained Congress, failed to repeal Obamacare was quite stunning to me, and is probably the primary reason for their losses of House seats in 2018.

In my research for this post, I learned that there is a phrase for our situation:  the "family glitch".  My husband's premiums with his employer-based coverage are "affordable" by ACA definitions, therefore we as a family are not eligible for subsidies in the exchange, even though our total cost is well above the "affordable" threshold.  Supposedly there are 2-6 million families in the same situation. That number looks a bit low to me, and probably there are millions of couples also affected.

I no longer bother complaining about these sorts of things, because I'm fairly sure that They are Doing Them On Purpose. If you remember, the ACA was shoved through to President Obama's signature quite rapidly, leaving little time for public comment or in-depth analysis. A law that long and complex is almost certainly bad somehow. It has been my opinion all along that the Democrats' intention with the Affordable Care Act was for it to pave the way for universal government-based health care. Their plan seemed to be that people with unaffordable health insurance would beg their employers to discontinue coverage, so they could then get affordable subsidized insurance on the exchanges. Edited to add:  Another piece of the plan was that the ACA mandated that people applying to buy insurance through an exchange would be funneled into a government health program if they qualified. Also, under the ACA, some hospitals can determine likely eligibility for government health programs, and sign uninsured patients up on the spot. From there, it would be a short step to universal health care.

What actually happened is that many people just tightened their belts elsewhere and made do, and then went out and voted Republican. Democrats have since proposed fixing the family glitch, but the fact is, that they have lost too many elections and no longer have the ability to do so. The Republicans in Congress certainly aren't going to help them; the ACA gave them back control of Congress...gift-wrapped.

I see in my analysis here further reason to doubt the long strings of stories in the media from 2016 to 2019 about how the election of Donald Trump to President definitely, for sure, had to be because of "Russian interference!".  After the Mueller report was released, the preferred explanation became "Racism!", now pivoting into "White Supremacy!". The idea that making millions of voters' health insurance even more unaffordable was a large factor in the Democrats losing the presidency is completely verboten.

Our other options for health insurance coverage are also unattractive. Buying insurance on the exchange without subsidies would cost more than we are paying with the employer's plan.  Medical sharing ministries are another possibility, but I have always felt hindered in my spirit from them; I don't know why, but possibly cheats and scammers are working their way into that field. We have avoided government insurance programs, for reasons that people who support the Right to Privacy and Right to Choose should understand. Also, in some cases some of these programs (Medicare, notably) can claim a share of a person's estate after they die, so they are not necessarily free money, but function more as an extended, no-interest loan for life.

I don't want government health care. I don't even want government subsidies for health insurance. What I want is to be able to buy the level of insurance that we can afford, and that best meets our family's needs. The government's job is to make sure that the insurance companies and health care providers play fair.