And Why Joe Biden’s Presidential Debate Misstatement Matters
Submitted by David Fick
There’s a mythology about pre-ACA health care in the U.S.: that people with preexisting conditions could not purchase health insurance. While that was true for a small number of people in thirteen states, it was largely untrue for the vast majority of Americans with preexisting conditions. Most people are covered under health insurance policies at their workplaces. If someone lost or left their job and had a preexisting condition, they could potentially have an issue buying insurance. However, at the time the ACA was passed, 37 states had high risk insurance pools that provided good coverage for virtually anyone who could not purchase a market rate health insurance policy due to having a preexisting condition. My wife and I were among those people, as I was a cancer survivor (prostate cancer, surgically removed in 2010), and was a diabetic, and she had an autoimmune condition, making both of us uninsurable due to preexisting conditions.
When I retired in 2010 at age 52, we were able to purchase an excellent Blue Cross policy through Maryland’s high-risk pool that covered both of us for about $850 per month. When the ACA kicked in during 2012, we were notified that our existing health insurance policy was being eliminated, and that along with roughly 4.7 million other Americans in the same situation, we were required to enter the ACA exchange to purchase replacement insurance. We did so, finding insurance that had far inferior coverage, with astronomically higher monthly rates and co-pays. Our new inferior insurance in 2012 cost 50% more ($1,250/month because it was age-based unlike our old high-risk pool coverage), covered far less, and had much higher copays ($12,200/yr. max out-of-pocket for a couple vs $5,000 under our old insurance). That was bad enough – and put the lie to Obama’s famous “If you like your health care plan, you can keep your health care plan” statement, repeated often while stumping for the program. But it got worse, far worse.
The following year we received a notice from Anthem Blue Cross that they were pulling out of covering our part of Virginia and terminating our coverage – and that we’d need to go back into the insurance exchange for another policy. We did so – but found that the ONLY policies offered in this, the poorest part of Virginia, were Bronze-level HMO’s – and that no PPO’s would be offered at all. Because we still owned a house in Maryland, we looked at their exchange and found a better policy there and purchased that one – but by 2017 the monthly premium for our PPO Platinum-level policy had grown to $3,100 per month and the annual out-of-pocket maximum was $14,400 – so before the policy paid ANYTHING for health coverage beyond an annual physical (which does not include the cost of tests or related medications), our annual medical expenses would have been $51,600. Lucky for us, in that year, Johns Hopkins University, where I am an adjunct professor teaching part-time at the Carey Business School, changed its policy and began providing coverage for limited-time instructors like me – so I now only pay about $650 per month plus a $5,000 annual deductible – a tiny fraction of what our inferior coverage had cost under the ACA.
The above demonstrates that the ACA was a financial disaster for my wife and me – but operated as it was intended to – we are reasonably well off, older – ineligible for any subsidy – and the ACA met its goal of using our funds to subsidize the roughly 9 to 11 million people it added to the previously uninsured rolls. On top of the incredibly high policy costs and out-of-pocket expenses, we were also hit with ACA taxes on investments and wages. But putting that aside, we might not have been as furious with the Obama administration’s over-reach if it worked. The law’s reach into the American family’s fiscal decision-making processes through mandated private product purchases, and requiring things like pre-existing conditions coverage, using a straw man that wasn’t really an issue for most people with pre-existing conditions, using weak excuses like mandated free birth control (for my 52-year old wife!) to call virtually all old policies “substandard” therefore worthy of termination – instead of fixing or tweaking the world’s best health system, they decided to blow it up and replace it with a new system designed to guarantee coverage and access to health care for all. If it did that, we might not object. But it didn’t. It did not even come close.
Except for the folks who received subsidized coverage through expanded Medicaid in the states that expanded their coverage, the one place where the ACA may have been “effective” in adding real coverage for people in need, it not only did not give more access to health care, it eliminated access to health care for many – including people who were previously uninsured but who had access to excellent health care. This included people we care about and love. One example is a family man who was employed at our oyster farm. We’ll call him Pablo, not his real name for obvious reasons.
Pablo was a parolee when the ACA became effective. He is a Mexican American who was born nearby, raised locally, never learned to read or write. A condition of his parole is that he cannot have an email address or access the internet. He is married and owns a home, is overweight and diabetic, has shortness of breath. His wife has a health aide job making about $18k/yr. Pablo made about $20k/yr. working on our farm, so combined they made about $38k/yr. in 2012 at the start of the ACA. Pablo and his wife had never had insurance coverage. I had Pablo and his wife come into our office with their tax returns and helped them use the Virginia exchange (creating a proxy email account so I could communicate on his behalf due to his parole restrictions) to obtain a fully-subsidized no-cost bronze HMO ACA policy (about $850/month premium but zero after earnings-based subsidy). Sounds like a win? Two weeks later, Pablo came into the barn and said “Mr. Dave, thank you so much, look, here’s my insurance card, the first health insurance I’ve ever had.” He was proud and happy – an ACA success. Or so we thought.
Two months later I saw Pablo working on cage assembly in the barn and noted that he looked weak, not well. I asked how he was doing, and he told me that he had stopped his diabetes meds, felt very bad. When I asked why, he said that he went to his normal appointment at Eastern Shore Rural Health to get his nearly free diabetes meds, his normal practice before the ACA, they told him that he had new higher copays after he showed them his insurance card, saying the copay scale was higher for those with insurance. He then had to pay for tests and a doctor to make a prescription, and found that the meds were over $500 per month, an amount he could not pay. Because his annual out-of-pocket under the new ACA policy was $6,600, he was essentially uninsured for both the essential doctor services and meds needed to keep him alive. While the ACA has provisions to help some poor with out-of-pocket costs, Pablo’s combined income of $38k put him above the level that would have provided this assistance.
The bottom line is that for working poor like Pablo and his wife, who previously had excellent access to health care through Eastern Shore Rural Health, the ACA provided him and his family with health insurance for the first time in his life, but denied him access to any real health care coverage, prohibitively increasing the cost of what he already had – the ACA was virtually killing him in front of our eyes. For people at the other end of the economic spectrum like my wife and me, it threw us off excellent policies, made our coverages from year-to-year precarious, created stress, and cost us many thousands of dollars. In 2014 I had open heart surgery, which with some complications cost about $37,000. My ACA insurance coverage in 2015 cost more than that – it would have been cheaper to pay for heart surgery out of pocket than to have health insurance.
This long diatribe brings us to Joe Biden’s big lie on Thursday night – “That’s why … not one single person with private insurance would lose their insurance under my plan, nor did they under Obamacare. They did not lose their insurance unless they chose they wanted to go to something else.” Well folks, you may not have personally been affected by Obamacare – but if you know Lee-Ann and David Fick, you know someone who was kicked off a policy they liked and wanted to keep – for something far inferior and far more expensive. And we know many others. Were some people helped through the ACA? Yes, but only those who are truly poor and were assisted through Medicaid expansion, or the few who lived in places without high-risk pools. The ACA blew up a very good system that could have been fixed through tweaks – a system that already covered 90% of Americans with the best medical care available anywhere in the world – we could write a whole other post about our personal experiences with health systems in the EU, Asia, Cuba, Central and South America, China, Nordic countries, but suffice it to say there’s a lot of incorrect mainstream news and political mythology about free or universal access to and supposedly superior payment systems for healthcare in the rest of the world.
So why does Joe Biden’s lie matter? Or was it a lie? Let’s give him the benefit of the doubt – maybe he’s really that clueless – maybe he’d truly unaware of how much damage the ACA did to real people like us and Pablo’s family – or maybe he believes that although folks like us lost one form of coverage, we did technically have an alternative under the ACA, albeit inferior and more expensive – but isn’t it still a reach to say we chose to go away? We were terminated, plain and simple. The fact is that he is promising doubling down more of the same on steroids – now proposing what he calls Bidencare. If we turn this country over to full Democratic control of the House, Senate, and the White House – this thing is a train on a track – not only all the ills of the ACA returned in full, but a new public option, which Biden promises will only be competition for private insurance – not a replacement. I do not believe it. It appears to be a Trojan horse for single payer, likely the strategy all along, and if we give full control to the Pelosi/Schumer/Biden triumvirate, it is coming.
I am no Trump fan as a person, but for me this is election is not about DJT or personalities – it is about policy. There are many other policies at issue in this election – but this one is personal. The ACA (Obamacare) was the Biden-Obama administration’s signature accomplishment. Reinforcing and adding to it is among Biden’s top priorities. I believe his health care proposals would be a disaster for this country. Biden’s statements about the ACA’s impact on my family and friends on Thursday night were not true. We did lose our coverage. Our costs did go up, by multiples. He says there will be no changes going forward unless we chose to do so. This is simply not credible. If he is elected and the Dems take the Senate, we will have new health care law. This is important stuff.