What is the conservative plan on health care?

With the Iowa caucuses 48 hours away, poor Ted Cruz just can’t catch a break. His debate performance was lame, his campaign got caught playing Big Brother with voters, and now he – rather than any of his competitors – had to field the killer question on Obamacare.

An Iowa voter confronted him at a town hall and told  the story of the voter’s wife’s brother,  a hard-working self-employed barber who couldn’t afford health insurance until the ACA came along. Then he felt sick, went in for a check-up, and was diagnosed with inoperable late-stage cancer. The voter’s question was straightforward: if you repeal Obamacare, what replaces it for people like my wife’s brother? (Left unspoken: if ACA had passed earlier, the brother-in-law might have lived.)

Cruz expressed ritual sympathy and immediately pivoted to his health-care talking points. The voter pressed for a real answer, but Cruz didn’t have one for him, just as none of his competitors would have had one. No Republican has proposed any actual substitute for the ACA formula of affordable health insurance for everyone who wants it.

Now, there’s an honest conservative/libertarian answer to that voter’s question; I’ve heard it from friends on that side of  the aisle. It goes more or less like this: Continue reading “What is the conservative plan on health care?”

“Pre-existing condition” gets personal: the case of Kevin Drum

Go ahead, libertarians and conservatives: tell me why what ACA repeal would do to Kevin Drum is OK with you.

Kevin Drum explains what would happen to him if ACA were repealed: due to his cancer, he’d be uninsurable. If his current employer folded – not a remote eventuality, in the world of magazine and online journalism – he’d be s.o.l.

Kevin, let us recall, is neither poor nor reckless. He didn’t choose to get cancer. He did choose to have health insurance. Nothing he could have done – short of working for a government or TBTF private outfit – could have protected him from the risk he will face if a Republican is elected President in 2016 and does what he will have promised to do in order to become the Republican nominee.

So, here’s a challenge to my conservative and libertarian readers:  Tell me, if you can, why that would be OK with you.

I promise to publish any literate and coherent reply verbatim, or link to any post elsewhere that answers the challenge.

Update A reader points me to this Megan McArdle post from 2012, which explains in detail how a little-known provision of HIPPA (a law that long pre-existed ACA) would protect someone in the position Kevin would be in should Mother Jones fold. Anyone who has continuously maintained health insurance is, apparently, eligible to buy new insurance without underwriting. That’s not much help to people who, when they lose their jobs, don’t have enough in the bank to keep paying for unsubsidized health insurance. But that’s not Kevin’s situation. Unless some health care wonk tells me otherwise, I’ll count my challenge as having been fully met, and will have to fall back on the other 69,000 reasons Friends Don’t Let Friends Vote Republican.

Second update Harold Pollack says there are more twists and turns. Yes, HIPPA protects someone who has been continuously insured, and who can afford to pay for health insurance without an employer subsidy after he’s lost his job. That would include Kevin. But what that person is protected against is only explicit discrimination in premium or coverage based on his pre-existing condition.  He’s still at the mercy of the individual-insurance market, whose products are often designed with “adverse selection” in mind: since some  healthy people who are unemployed or self-employed or employed without health benefits will decide to go uncovered rather than pay the full cost of health insurance, the individual-insurance market will have a higher share of sick people, and insurers tend to tailor their individual plans accordingly.

In the absence of ACA, insurers could and did exercise many non-underwriting strategies to avoid high-cost individuals or to impose high out-of-pocket costs on these individuals. Some of the most obvious issues included stringent annual and lifetime caps on dollar coverage now abolished under ACA. There were also limitations on benefits now included in ACA’s essential health benefit structure. HIPAA left untouched many aspects of coverage important to cancer patients and others with costly conditions. 

As I noted here, groups such as the American Cancer Society’s Cancer Action Network and the National Multiple Sclerosis Society had good reason to rank among the leading supporters of universal coverage.
So while HIPPA did protect a rather narrow group of relatively well-off people against the specific suckage of “underwriting” based on pre-existing conditions, they were still fully exposed to the general suckage of the individual health insurance market.
So, with that amendment to the question, this column is still open to any ACA opponent who wants to explain why we should be willing to subject ourselves to that sort of risk.

 

 

 

Evidence of safety nets as trampolines

There’s a spike in small-business formation when people become eligible for Medicare and don’t have to fear losing health insurance if they leave their jobs.

Just as James said, people in the U.S. become much more likely to start a small business when they become eligible for Medicare. That’s a like benefit of Obamacare that doesn’t often get mentioned.