The Problem With Obamacare and the Real Reason Insurance Companies Cancel Polices

Now that President Obama has said it’s OK with him if insurance companies keep their policyholders in health plans that don’t meet the standards established by the Affordable Care Act (ACA), at least for another year, the big question is whether insurers will take him up on the offer.

The answer: it depends.

Karen Ignagni, president of America’s Health Insurance Plans, the industry’s big PR and lobbying group issued the following statement when trying to justify why insurance companies have every right to cancel policies:

The only reason consumers are getting notices about their current coverage changing is because the ACA (Affordable Care Act) requires all policies to cover a broad range of benefits that go beyond what many people choose to purchase today.”

In other words, they require us to do our jobs and actually have health maintenance in mind when in reality all we want to do is make profit and pretend to offer services to people we have no intention of ever paying because doing so cuts into our profit margin – which is what we are after and nothing else: profits.

And that, in a nutshell, is the whole problem with the health care system in this country and Obamacare (ACA) by extension.

The reason for the cancelling of such policies is that insurance companies make money by denying people health care. That is why they have such things as high deductibles (or deductibles at all), as well as premiums or higher premiums when the benefits package get bigger. That is also why insurance companies constrain their customers in a limited network of doctors and hospitals and call the shots about whether a knee replacement or liver transplant your doctor recommended is really necessary. In other words, they make health care decisions for you.

I wish people would, once and for all, understand this about insurance companies: they are not in it for your health, or to protect your health, they are profit rackets out to make money off of you. And the way they do that is by charging you a lot but paying off very little when it comes down to it and when you need to actually utilize the benefit you paid for.

Ever since Obama announced the ACA, insurance companies have been working on finding other ways to keep profits high and your benefits minimal: they migrated their customers from traditional managed care plans to so-called “consumer-directed” plans, the industry euphemism for high-deductible policies, requiring people to pay more out of their own pockets for care – which really is just a strategy to reduce benefits. Investors and Wall Street financial analysts refer to these common industry practices as “benefit buydowns.”

Under the ACA, a lot of, most notably poor or even struggling middle class folks (remember, the middle class is no longer what is used to be)  are stuck with the Silver and Bronze plans under the ACA that have something like $5000 and $10,000 deductibles. How is an individual making 25k a year, or 35k or even 50k to come up with a $10,000 deductible? That is a lot of money and they may as well not have insurance.

Under this supposedly amazing “reform”, you end up paying a lot of money in premiums each month and still get nothing from them until you meet your 5k or 10k deductible. Remember that a lot of preventive care and just normal medical procedures cost less than $10,000, so by placing the premiums this high, insurance companies effectively end up with just collecting your money and still have you pay for everything else – unless something catastrophic happens – but even then you still have to meet your 10k deductible before the benefits kick in.

And that is why they are cancelling insurance premiums now: under the ACA they have to make certain basic, minimum services available which they don’t want to do because that undermines their profit. So they kick you out because it is cheaper that way or they change your plan and increase the deductible. 

ACA: Insurance Reform, Not Healthcare Reform

The Affordable CARE Act is actually only an insurance reform, not a health care reform and either way you look at it, insurance companies still get the upper hand and are the ones winning and really nothing has changed in terms of who gets to make health care decisions for you. It’s just that now the matrix has been altered and as long as insurance companies do not blatantly violate the laws set forth in the ACA –  and instead find a way around them, which they have, they can go on with business as usual.

In order to have true, meaningful, effective health care reform, insurance companies need to be removed out of the health care business.  The fact that the ACA did just the opposite, namely make insurance companies an integral part of this so called reform by promising them every single person in this country , under penalty of law, as prey customer,  makes it a weak policy and pseudo reform.

Entities that have solely a profit motive in mind and that make money by denying claims, should not be in charge of making health care decisions for us.

ACA is a Conservative Idea

Remember that the core principles of the ACA were all originally conservative in nature. In fact, the idea of an individual mandate was popularized by the Heritage Foundation and other conservative think tanks as early as 1989.

In 1992, Heritage proposed a sweeping reform it called the Heritage Consumer Choice Health Plan. Among the plan’s features:

Require all households to purchase at least a basic package of insurance, unless they are covered by Medicaid, Medicare, or other government health programs. The private insurance market would be reformed to make a standard basic package available to all at an acceptable price.”

As President Bill Clinton began to push for a government-run system in 1993, Republicans introduced bills that included an individual mandate. At the time, Newt Gingrich hailed them:

I am for people, individuals — exactly like automobile insurance — individuals having health insurance and being required to have health insurance,” he told “Meet the Press” in 1993. “And I’m prepared to vote for a voucher system which will give individuals, on a sliding scale, a government subsidy, to ensure that everyone as individuals has health insurance.”

It is, of course, quite ironic that the same people who supported and championed something similar to the ACA, ended up shutting down the government and causing financial harm to this country last month because of their opposition to the ACA under Obama (although their opposition was directed toward Obama really. Yes, Republicans hate Obama more than they love their country).

The ACA, which is basically just a scrambled version, or in fact exact replica of the Heritage Consumer Choice Health Plan, is therefore, a very conservative, Right wing piece of legislation aimed primarily at securing the business interests and profit margins of insurance companies. It has nothing, whatsoever, to do with offering people affordable, quality health care and its implementation is not health care reform.

There is nothing liberal about Obamcare and the idea of turning to the private market – which, by its very nature, does not care about common welfare but profit – as providers of health care to citizens is  in direct contradiction to the very principles of health care reform and why we need health reform in the first place.  It would be like depending on Bain Capital or Koch Industries for Medicare, social security, disaster relief and even governance. Entities that are in it for the money and the money only, however do not have any business being tasked with providing as well as securing basic necessities and rights, which access to health care, is.

As a progressive who is a strong supporter of a single payer system and/or universal health care, I view the ACA is nothing but a lousy, unholy bargain people are being forced to strike and like even.

The argument by its proponents is that it is better than nothing – and that may very well be true – after all, every little something is better than nothing and if you go by that mentality then you don’t ever have to complain about or try to change anything in life. But can we call that reform? Change? Even the beginnings of it? Is it reform when we, on a very fundamental, philosophical level, believe that peoples’ health should be in the hands of profit rackets in the form of insurance companies and that such entities should be at the core of any health care “reform ” and tasked with making healthcare decisions for us?

The only ones I see winning in this are insurance companies that have already found a myriad of ways to circumvent the provisions of the ACA. The consumer, the sick person in need and without the assets, will just be taking it up the ass and end up with nothing. Remember, those stuck on the Bronze and Silver plans (note that certain income levels don’t even qualify for the Gold and Platinum Plans- i.e. the poor), still won’t get the care they need  because of high deductibles -so for them really nothing changes because that 10,000 may as well be a million because they dont’s have that either.

Yet, what worries me is that if this health insurance reform or whatever it is somehow fails, it is going to set back meaningful healthcare reform—single-payer, universal healthcare, i.e. Medicare for all—for who knows how much longer. It would be a very long time before a healthcare reformer can make a proposal without the specter of failed Obamacare haunting the national discourse.

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