Facts and risks of repealing the A.C.A

Republicans have all the power in Washington, D.C., and the idea of repealing the Affordable Care Act (ACA) is no longer a mere phantasm. The policy choices are politics, but the issues faced by us in terms of healthcare and the problems solved (poorly or well) by the ACA are facts.

This week, I thought we’d look at some of those facts.

Health care is one of the largest expenses in society, yet health insurance is not a “right.” Until the ACA, regulation of the health insurance industry was a hodge-podge and going onto the open market to buy health insurance was a nightmare. Also, the pool of those covered by insurance was partly sicker, because the healthy said “why bother” with respect to coverage, and partly absent. Those too sick or too pressed for money were uninsured and would seek high-cost emergency care for which the cost, if a person was indigent, was eventually indirectly borne by local taxpayers. The only constant were rising unchecked insurance company profits and pocket-book busting health care costs.

For the vast majority of us, we had no idea what was really going on. This veil of ignorance starts with those covered through Medicaid or Medicare. Although Medicaid and Medicare have some bargaining restrictions with health care providers (like, inexplicably, negotiating over prescription drug costs), the true cost of healthcare to recipients is hidden. The government used its clout to negotiate prices and we just showed up with our insurance card to pay for services.

However, the vast, vast majority of Americans acquires health insurance through private or public employment. In the private sector, this is an echo of when unions were more powerful and demanded health insurance coverage in collective bargaining. What was once just a union benefit, though became de rigueur for most major employers, e.g., more than 50 employees, governed by something known as “ERISA.”

Government is also an employer at the state, federal and local levels, including military service members and dependents (the VA system is really a different model and also, as we know, dysfunctional). Generally speaking, governments provide decent health insurance at reasonable costs, although as healthcare costs have risen, so have premiums and the costs to employees.

The theory of the ACA experiment is that it would keep health insurance and health care costs by making plan requirements more uniform. Also, by creating a more transparent individual marketplace, laborers would have more employment choices, as opposed to be tethered to a job for health insurance.

For those of us who had insurance, our minimum benefits would be expanded. Thus, for example, lifetime caps and pre-existing exclusions were eliminated, and young adults could keep their parent’s coverage until they turned 26 years old. Women were finally guaranteed rights similar to men and their premiums could not be greater than for men. The trade-off to increasing expenses to health insurers was “lazy” healthy Americans would be forced into the health insurance pool, expanding a risk pool with new customers.

Eliminate the ACA and these minimum plan requirements fade away. In theory, some of these new “rights” could be protected by amending statutes like ERISA. Also because large companies and governments might have the bargaining clout to force insurance companies to maintain popular ACA-mandated plan terms. Premium expansion costs also might be kept fairly benign because of the large pool of employees.

This rest of us would be thrown back into the wild-west that is the health insurance market. The ACA tried to expand Medicaid coverage to reduce the number of uninsured. If the ACA is repealed, the first casualties will be those dependent on the ACA’s Medicaid pool expansion.

Small businesses and individuals lack the clout of large enterprises or governments. Due to anti-trust laws, we (I include myself) cannot go out into the marketplace and form a cooperative or trade union adding small voice to a broader bargaining entity. Pre-existing conditions would certainly return, as well as lifetime caps on benefits. What happens to someone with a history of high blood pressure, diabetes or skin cancer? If we had to forego insurance, we would face a double whammy. First, having to pay out of pocket; second, that without the protection of insurance contract, a provider charges you an inflated “full freight” fee, as opposed to the reduced fee charged for the insurance card carrying patients.

The point of this column is not to “cheer-lead” for the ACA; rather, it is to explain facts and risks of repealing it. Every one of us has something to lose. And for those of us not so lucky to have insurance provided through a large company or by a government, the “free market” is an ugly place to visit without a tight regulation in place like the ACA.

Warner Robins attorney Jim Rockefeller is the former chief assistant district attorney for Houston County and a former assistant state attorney in Miami. Owner of Rockefeller Law Center, he has been in private practice since 2000. Email your comments or confidential legal questions to ajr@rockefellerlawcenter.com.

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