So often what is missing from the healthcare discussion is context and history. People quickly forget. They forget what insurance was like before the Affordable Care Act was passed:
• Every year, insurance companies were increasing premiums by double digits.
• Anyone with a preexisting condition had to wait 12-18 months after signing up for an insurance policy before it would cover any care related to the preexisting condition; that was called the “waiting period.”
• If, for some reason, you lost insurance and did not start a new insurance policy within 63 days, you lost your “continuous coverage” and had to start again at 0 with a preexisting condition waiting period on your new policy.
• Insurance policies had both annual and lifetime maximums. A plan’s lifetime maximum was usually $1 million. Because medical care is so expensive in the U.S., people needing treatment for cancer or premature, ill babies often racked up bills of $1 million or more, at which point the insurance company would call and say, “You’ve used up all your insurance—we won’t cover your care any longer.” The result was medical bankruptcy (and/or death).
• If you had insurance through your job and left the company, you could get COBRA continuing coverage for 18 months (provided the company had more than 20 full-time employees; companies with fewer employees were not required to offer COBRA). But, you had to cover both portions of the premium: the percentage you paid as the employee, and also the percentage that your employer paid for you. This often made COBRA insurance prohibitively expensive.
• You could buy a “short-term” insurance plan to tide you over until you got another job, but these plans often have skimpy coverage.
• If you were age 21-64 and did not want to find another job, preferring instead to work as a freelancer or to follow your dream and start your own business and be an entrepreneur, you had to shop for insurance in the “individual market.” If you had a preexisting condition, most likely you would be rejected for insurance outright (failed the underwriting); or, if you did find an insurance company that would sell you an individual policy, it would be very expensive or it would exclude coverage of any medical care related to your preexisting condition.
This individual market, consisting of people 21-64, is primarily what the ACA (Obamacare) was designed to help. People still do not understand this, and more education needs to be done so that people who may benefit from the ACA sign up for it. Here’s the breakdown:
1) If you are age 21-64 and you work for a company that offers health insurance to its employees, you are covered through your employer’s (private, for-profit insurance company) policy.
2) If you are age 21+ and are unable to work at all due to disability, or you work but earn wages that are at or only slightly above the poverty level, you automatically qualify for health insurance through Medicaid. Medicaid is a state-run (government)insurance program.
3) If you are age 65+, you automatically qualify for health insurance through Medicare, a federal (government) insurance program that offers hospitalization and additional insurance benefits to seniors.
4) If you are in the military or a veteran and meet the requirements, you automatically qualify for health insurance through Tricare, a federal (government) insurance program offering health insurance for the military and their families.
Now, some people may have insurance through one or more of these programs at the same time. For example, seniors may qualify for both Medicare and Medicaid together. Some veterans may have both Medicare and Tricare coverage. Some seniors may be retired but still receive insurance benefits through the for-profit insurance company used by their former employer, as well as Medicare at the same time.
Now, if you are not in any of these 4 categories, what do you do? You go online to healthcare.gov and you look at the available policies in your state, find one, and sign up for it. This is Obamacare. If your income is above the poverty level but still toward the lower end (ie, maybe $25K to $35K), you most likely will qualify for a premium subsidy that will help you pay the cost of your monthly premium. For example, if you find a Silver level plan you like on Healthcare.gov, and the monthly premium is, say, $625, that might be too expensive for you. However, if you provide your income information, they will come back with a subsidy—say $400. So, for that monthly $625 premium, Obamacare pays $400 of it and you pay the rest, or $225. Now the insurance premium is more affordable for you, and you can enroll in an insurance plan that meets your needs.
Yes, some self-employed people and business owners earning more money (closer to $75-$100K) have experienced high premiums and deductibles. But this is something that can be fixed. Meanwhile, many people still no not understand that Obamacare is an option for them.
This morning on MSNBC, a reporter spoke with a Trump voter in a red state, a young lady named Cassie (I think) who owns a business. She said she does not have insurance and was glad that the Republican healthcare plan failed, but she was hoping that Trump will come up with another plan to do healthcare. The reporter should have asked her, “Have you gone to Healthcare.gov to sign up for Obamacare?” Cassie is one of many people in the country who still do not understand that Obamacare was made for them. She could go to Healthcare.gov and enroll in a plan that would meet her needs. Maybe she just doesn’t know that Obamacare is an option for her, or maybe she doesn’t like Obama and for that reason doesn’t believe that the ACA can help her.
When the ACA first was rolled out in October 2013 (for January 2014 sign-ups), the Obama Administration did a terrible job. First, the Healthcare.gov website was plagued with glitches, and people who wanted to couldn’t sign up. They also did a poor job of communicating to the public what Obamacare was all about, how it works, what it covers, and who can benefit from it.
From Day One, Republicans have been spreading lies and disinformation about the ACA and have been working to sabotage it by trying to shorten the enrollment period and get rid of insurance navigators who can help people work through the website and sign up.
Obamacare covers individuals with preexisting conditions. It covers those 10 Essential Benefits that the Freedom Caucus Republicans wanted to cut. Obamacare does not have annual or yearly plan maximums.
Now, more than ever, the ball is back in our court. We need a renewed focus on educating the public about the ACA and Healthcare.gov, so that people who need insurance and don’t have it understand that yes, in fact, there is someplace where they can get affordable health insurance.