The Affordable Care Act and I have never gotten along. As a healthy person who purchases their health insurance in the individual market, I had a target on my back. For the Affordable Care Act supporters there is something evil about healthy people that needs to be suppressed. I don’t understand their quixotic logic but wishing it would go away is not helping. So I reluctantly assumed the position of designated whipping boy in their quest for health care reform. I was told to overlook my plight and remember that my sacrifice will usher in a whole new era of health insurance for for the uninsured and chronically ill. My inner cynic said that it seemed more of power grab than a genuine concern for the good of others. It reminded me of this line out of the novel, 1984.

“The Party seeks power entirely for its own sake. We are not interested in the good of others; we are interested solely in power, pure power.”

Still I was comforted by those conservative principles expressed by the President and other Affordable Care Act supporters that said I could keep my insurance and doctor if I wanted to. I even took the President up on his offer to look for a better health insurance plan offered in the exchanges. Surely the supporters would carry over enough of the old system to avoid an unnecessary introduction to Murphy’s Law. At the very least, they would offer a more affordable insurance option through the exchange. I looked, analyzed the plans, and finally decided  that for the President and the Affordable Care Act supporters, words are cheap! It was just a means to the end. I was happier when I thought I was the only Affordable Care Act loser and am disheartened to see that they seem to have gone out of their way to piss off people. So let me identify my first five losers you may not be aware of. I am keeping number 6 for another day.

1. The subsidies for the individual market come from that odd political threesome of Medicare Advantage “overpayments”, a tax on medical devices, and extending Medicare tax on incomes up to $250,000. So let me see if I understand this. We are taking money away from Medicare to subsidize insurance for the young in the hope that if enough young people sign up we will have enough money to subsidize those folks who have pre-existing conditions who are predominately elderly. If that is not weird enough for you, the only bipartisan agreement in health care debate is to revoke the tax on medical devices since it will likely increase health care costs. The only sustainable part of this plan that does not increase health care costs elsewhere is to increase the Medicare tax on the wealthy. It may be gallows humor but it sure looks like the politicians are gleefully looking forward to a massive to a passive, aggressive experience.
2. I was surprised to find that even with a subsidy I had to choose a HMO plan with a pretty narrow hospital network that I am not familiar with or pay a lot more money for a PPO that covers my network. As Ezekiel Emmanuel might say, “You can keep your PPO if you willing to pay more money”.  Is my preferred hospital network a loser? What made them a villain?
3. I was surprised and humbled to find that the insured but chronically ill people can be losers, too. I never expected that the Affordable Care Act would screw the chronically ill! If the doctor or hospital you are using is not part of the exchange insurance plans, you are going to have to change. In other cases the doctor and hospitals are covered but at a much higher cost.
4. As Emmanuel and Gruber will readily admit, it was part of the Affordable Care Act plan that a lot of insurance plans would be canceled and replaced with insurance plans that covered the “Essential Benefits”. The first phase was to cancel the health insurance available via the individual market. I suspect that the people with canceled plans are in shock. Since they are forced to be Early Adopters of www.healthcare.gov and pay higher insurance costs, they are responding with a very typical passive, aggressive response. A typical response by these designated losers is that the Affordable Care Act was supposed to screw “other people”, not them. At least they had showed the individual responsibility to purchase their own health insurance without a government subsidy. The second phase is going to get a lot more dicey since many of the grandfathered individual and group plans will be canceled in 2014. I doubt our politicians want to go to town meetings with a large group of people who have just found out that they are Affordable Care Act losers.
5. I am still puzzled how does one replace Medicaid with a subsidized health insurance plan? I have a relative who is struggling with getting her life back together again after multiple bouts with unemployment. If she goes to www.healthcare.gov she will be automagically enrolled in Medicaid if she tells the truth about her income. If she knows the Medicaid income limits and purposely lies about her income, she can get a subsidized plan. I was curious what she might do since I believe that she is a good prospect to purchase and maintain health insurance. In her transition from part-time to full time employment this would be a nice personal goal. It certainly would enhance her self-esteem if there was a path for her to start paying for health insurance that did not require lying. I realize that the Affordable Care Act plan was to automagically enroll people in Medicaid if they have insufficient income. This fulfills a quest by Affordable Care Act supporters to reduce the number of people without health insurance but it creates a new problem.  How do we encourage people to transition people from Medicaid to subsidized health insurance to normal health insurance? Between these two quests which is the greater good or can we do both? Is this a case where life imitates art and “you can check out anytime you like, but you can never leave”?

Image courtesy of Wikipedia.