This week’s show starts out with a detailed look at the American Health Care Act, which the House of Representatives passed in a squeaker of a vote. Both Mike and Jay expect that the Senate will take up and pass some version of the AHCA, but that it’s likely to be somewhat different from what the House approved. In their discussion of the bill, the Guys discuss where people get their insurance, what Obamacare did (or tried to do), and how the AHCA would change things.
Next, it’s a look at the bipartisan spending bill that Congress recently approved, with almost all of the opposition coming from Republicans. Mike and Jay talk about why so many Republicans were against it and whether or not conservatives are right to be worried about federal spending and debt levels.
Finally, the Guys introduce a new segment to the show: What We’re Reading. Every week, Mike and Jay will talk about an article, book, podcast episode, or documentary they’ve been reading, listening to, or watching, in an attempt to break away from the of-the-moment, ‘instant analysis’ of the news cycle.
What We’re Reading Links
– Why the Reactionary Right Must be Taken Seriously. Andrew Sullivan
– The Challenge of our Disruptive Era (paywall). Senator Ben Sasse
I want to start this off with saying that I enjoy your show very much and generally do not feel the need to correct things said on the show, even if I disagree, as you both tend to be very measured and thoughtful; however, in this case Jay made some very incorrect statements. Jay is incorrect about how pre-existing conditions worked prior to Obamacare. I do get annoyed when people talk about this topic as it seems very few people understand or remember what it was like (or perhaps they lived in a state with lot of regulations which made things more like Obamacare or perhaps they did not have preexisting conditions so did not know what it was like). I have asthma, and as asthma goes, mine has been fairly well controlled my whole life, and does not keep me from being active and staying fit, but I do have to take medication daily and see a specialist twice a year and I have increased risks of developing complications anytime I get a cold. With all this said, I understand why insurance companies do not want to cover me — I am a known increased risk; a bad bet. There may have been states that required insurance companies to sell to people with pre-existing conditions, but I never lived in one of them. I could not buy health insurance for any amount of money before Obamacare. In terms of work insurance, pre-Obamacare, I think it is important to remember that MANY employer based healthcare plans had a 30-90 day wait period before you got health insurance benefits (this is part of why COBRA was established). I worked in healthcare during a volatile time (during the healthcare recession in 1996 after the balanced budget act changed how Medicare reimbursed physical therapists) and had the company I worked for change 5 times in a year (I worked in the same facility doing the same job — the companies that contracted with the facility to provide therapy merged, sold or went out of business). During that year I was effectively not covered due to the waiting periods with each new company. ADDITIONALLY it is important to note that pre-Obamacare even employer provided health insurance had pre-existing condition clauses — when you worked for a new company, if you had been treated for a diagnosis within the prior 3 months (or some other time period, 3 months was what I often experienced), your EMPLOYER based health insurance considered that a pre-existing condition and would NOT cover that condition unless you went a year without needing any treatment for it. That is why some people were stuck in jobs — if you had a serious medical condition, you could not hope to get coverage for it unless you stayed working for the same company. I remember this vividly in the 1990s because of my preexisting condition of asthma. I went without treatment (doctor visits or buying new medication — I horded my medications to use during these times) for my asthma for a year so I could get it off my employer’s insurance as a preexisting condition and anytime I was planning on changing jobs, I made sure to go without treatment for three months prior to looking for a new job. This was not a huge deal for me because my asthma was not that bad, and I was lucky that I still had left over medication (although to be honest, I might have been committing insurance fraud by using the medication during that time, even though I was not under a doctor’s care, it might have counted as being treated, I’m not sure). I also remember the preexisting condition problem coming up in the 2000s when I was pregnant. I was offered a great job when I was pregnant but decided not to take it after I spoke with the new company’s insurance rep as they were clear that my pregnancy was a preexisting condition and that they were not going to cover it. I think it is important for Jay to understand that his version of what insurance was like prior to Obamacare is not correct for everyone (as I’m sure my experience is not correct for everyone), but to blithely say pre-existing conditions were not an issue or were addressed adequately prior to Obamacare is completely false.
Thanks for bringing up those important points! While I feel there were many flaws in Obamacare, I’m proud that my party was able to pass legislation that helped out millions of Americans. – Mike
Just to clarify — pregnancy not covered in 2000 due to having c-section with previous pregnancy (was going to need c-section — no OB in my area at that time would even consider a VBAC). I believe HIPPA (1996) mandated that pregnancy could not be considered a preexisting condition, but insurance told me c-section was preexisting. Also HIPPA mandated that employer plans insure you even with a preexisting condition EXCEPT: “Your new plan can require that you satisfy a preexisting condition exclusion period, meaning if you have been treated for a condition within the past 6 months, the new plan is allowed to exclude it.” http://healthcare.findlaw.com/patient-rights/hipaa-the-health-insurance-portability-and-accountability-act.html
So while I did get health insurance, it didn’t cover my asthma if I had been treated for it.
I’d like to echo and elaborate a bit on Tammy’s completely correct point. While I generally find Jay’s points to be well-informed, he was very mistaken, and very misleading as a result, about pre-ex conditions and guaranteed issue. I don’t know if Ohio was different, but in Florida you could absolutely be denied individual coverage based on pre-ex conditions. While group commercial coverage was generally guaranteed issue to any eligible employees, there were still some specific pre-ex exclusions from enrollment even on a group plan. Other pre-ex conditions would trigger a one year wait period (similar to the look-back policy Tammy referenced) before coverage for services related to the condition would be covered under the plan. It was entirely possible for children with certain conditions to be forced to enroll their underage children separately in Medicaid even if the parents were eligible to enroll in a plan. You also cannot forget about lifetime maximum benefits that made health insurance nearly irrelevant but for the negotiated rates for people suffering long term illnesses.
The real elephant in the room that was not discussed, perhaps intentionally, are the ballooning medical “costs” (the inflated prices charged by providers). These prices get inflated because insurance companies build provider networks and negotiate lower rates for services within these networks and so provider prices naturally climb higher as a result (deal-making, right?). Unfortunately for the uninsured, providers often will not discount these vastly inflated prices for individuals forced to pay out-of-pocket.
I understand Jay’s point about rising premiums even within group plans due to mandated essential coverages and mental health parity. These criticisms are valid, however the proposed rollbacks of some Obamacare requirements will put many families back in the ranks of the bankrupted, with no light at the end of the tunnel no matter how well they plan or how hard they work.
Thank you for the excellent comments about the pre-existing conditions before the ACA, it was definitely a problem. I knew many people that could not change jobs due to pre-existing conditions. It disappoints me that Jay is so mistaken about this.
Also, to say that the people that did not have health care before the ACA choose not to have insurance is again not understanding the high cost of health insurance for individuals whose employers did not offer health insurance.
My husband is a surgeon and after the ACA passed, he is able to see patients before the cancer has spread throughout their bodies and consequently, he is been able to save many more lives.
I am a regular listener of this podcast and it is almost always excellent because both Jay and Mike are well educated on the topics and do a fantastic job of discussing the issues in a calm manner. With that said, I was appalled when Jay suggested you agree to disagree after Michael clearly explained that people being priced out of the market is the same as them losing coverage. Michael asked Jay point blank if he was dismissing the CBO findings to which this was your response. Unbelievable.
Jay then further minimizes the impact of this bill suggesting that premiums would be brought down because of increased flexibility in tailoring health plans to be more competitive. There is no free lunch in life. Premiums would be coming down because this bill would allow insurance companies to save money by not covering the sickest people in the country. Furthermore, Michael is right that removing Medicaid expansion would effectively remove coverage for millions of people. Others have already commented regarding Jay’s flawed thinking on preexisting conditions so I won’t address that. Jay mentioned that eventually the ACA would move the burden of Medicaid payments to the states, leaving us in the same boat. That may be true but that only suggests that we should improve the current system, not destroy it and replace it with something that is worse for the sickest people in this country.
Regarding premiums, have they gone up on employer insurance plans? Yes they have and I can say mine have gone up as well but that is because we are being asked to cover those that are less fortunate. In simple terms, this would cause premiums to go down but it would be at the expense of the poor and the sick. To dismiss this fact is, at best, simply dishonest. Everyone knows the answer here except some are too embarrassed to admit it. Running health coverage as a ‘for profit’ business will always be immoral. This is the United States and we can do better. Jay, you can do better as well.