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Kevin Drum explains what would happen to him if ACA were repealed: due to his cancer, he’d be uninsurable.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: Â 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.
UpdateÂ 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. Â He’s still at the mercy of the individual-insurance market, whose products are often designed with “adverse selection” in mind: since some Â 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 didÂ 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.Â
As I notedÂ here
, groups such asÂ the American Cancer Societyâ€™s Cancer Action Network and theÂ 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.