Thoughts on Taxes and Obamacare

IMG_8302Okey-dokey, resisters. This week was sucktastic. The new tax law is sucktastic. The implications for the economy as a whole are sucktastic. The implications on health insurance are sucktastic. BUT! The overall outcomes for health care policy are not nearly as sucktastic as I was afraid they would be at the beginning of the year.

Lemme go back to Obamacare basics for a minute. The big goal of the ACA was to make sure anyone who wanted insurance could buy it and they could keep it regardless of health status. To do that, legislators needed to impose regulations on the health insurance industry. To do that, law did four big things to the industry:

  • It set essential benefits that insurers needed to offer instead of letting insurers decide what plans would and would not cover.
  • It required insurers to sell a plan to anyone who applied instead of allowing insurers to deny plans to people with pre-existing health conditions.
  • It removed annual and lifetime coverage caps instead of letting insurers cut off coverage after a patient reaches certain dollar amount of care.
  • It disallowed the practice of insurers cancelling policies for reasons other than non-payment of premiums.

The other major change for consumers who were purchasing plans on their own (as opposed to getting insurance from their employers) was the establishment of subsidies to offset premium costs.

Now. Of course these are not the only things the law did. As any Republican will tell you, the health insurance law was thousands of pages of incomprehensible policy gobbledygook. But those are the consumer protections that I believe to have the greatest impact on all of us.

And you know what? As of today, December 22, 2017, all those provisions are intact.

The only major change Republicans have been able to make to the law is the repeal of the so called “individual mandate”  that imposes a fine on people who voluntarily decline to purchase health insurance.

Now, there is a concern that pulling that plug will cause some major repercussions in insurance markets. The theory goes that without the fear of a penalty, young, healthy people will drop out of the market, leaving insurers covering a disproportionate number of older, sicker people with higher costs. Without the revenue from healthy policy-holders to balance those costs, insurers will have to raise premiums on the rest of us. And that will probably happen.

For those of us who get insurance through work, we and our employers will see added costs in the years to come. For people buying through the marketplaces and getting subsidies, they’ll also see added costs but, as I understand it, subsidies are scaled as a percentage of premium cost so the subsidies will rise with the prices. I’m optimistic enough to hope that most of us won’t be priced out of the insurance market entirely but I’ve been wrong before so don’t quote me.

All of this is to say that, so far, the only thing the Republicans have been able to change about insurance is the part having to do with money. The terms of insurance policies aren’t changing. The rules about who can purchase insurance aren’t changing. And decisions about when enough care is enough are still in the hands of doctors and patients, not insurance companies.

We did good, resisters. We held the line on a lot of important stuff and we’re entering 2018 with a lot of important benefits intact. Pat yourself on the back.

I’m cautiously optimistic that Congress will leave health care alone in 2018 because they learned the hard way that health insurance is a radioactive subject. They do not want to fight these fights in an election year. That doesn’t mean we can relax entirely but this probably won’t be the biggest battle of the coming year. Keep an eye on the headlines and be ready to move but don’t be surprised if healthcare policy stays out of the news for a while.

Happy holidays, friends. You did a lot of good this year. We all did.




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