Rep. Fred Upton's bill in the House, which would give insurance companies the option of continuing for a year the health insurance plans they have just canceled, is the first significant Republican effort to reform instead of kill the Affordable Care Act. Of course, it has a major downside: The number of those populating the exchanges will be smaller, and less healthy, because the individuals who will most want to keep their plans are the ones insurance companies cherry-picked due to their good health. But the bill at least acknowledges the reality that Obamacare is here to stay.
Will it be the first of a series of steps to adjust the ACA? I doubt it. The zeal to trash and sabotage Obamacare is now deeply seated among Republicans in and out of Washington. That zeal has nothing to do with the botched rollout of Healthcare.gov or the president's broken promise about the ability of everyone to keep his or her plan, much less the fundamentals of the act.
A good case study in this zeal comes from the Washington Post columnist Charles Krauthammer. In a recent column, “Obamacare Laid Bare,” he challenges the entire structure of the Affordable Care Act.
Krauthammer does not like President Obama any more than he likes green eggs and ham, as evidenced by the fact that he can’t help but make two references to Benghazi and one to the IRS in a column on health policy. He attacks the plan for throwing far more people off their insurance than it can possibly be signing up on the exchanges. He lays into the idea that those with individual health plans will now be forced to pay for coverage they do not need: “So a couple in their 60s must buy maternity care. A teetotaler must buy substance-abuse treatment. And a healthy 28-year-old with perfectly appropriate catastrophic insurance must pay for bells and whistles for which he has no use.”
Lost in this analysis is any sense of what the Affordable Care Act does and why, much less any link to the reality of what insurance is and what it does. Exhibit A in the latter case is the set of charges about the rank unfairness of forcing people to pay for coverage they do not need. My wife and I are a couple in their 60s—and we pay for maternity coverage, as we have for decades after we needed it, as part of our group insurance via my employer. When I was in my 20s, I paid—as part of my group insurance at a university—for all kinds of coverage for ailments that hit those in their 60s but were not at all relevant for me. That is what insurance offered to groups of people does.
That reality has always been true for those of us, the vast majority of Americans, who get their coverage through their employers. It is also true that for some very healthy individuals who have not had the ability to secure insurance through an employer or group, they could tailor their coverage to exclude items they would not need, or could gamble that they would not need. But for most—including many of those so privileged—the individual market has been a jungle.
Whether unemployed, working for an employer who does not provide insurance, or between jobs and no longer eligible for COBRA, individuals seeking insurance have faced a market where preexisting conditions—even as trivial as acne—might be enough to deny coverage, or to have coverage suspended when the insured gets seriously ill. Finding insurance on the market was its own nightmare even for sophisticated individuals, as I discovered some years ago when I was shopping for insurance for my able-bodied son, whose Ivy League degree did not bring with it a job that offered health insurance. I went on ehealthinsurance.com and found an impressive array of plans available to him at different price points. But once I got past the initial paragraph describing the basics, discerning what each policy actually covered and didn’t cover was virtually impossible. Comparison shopping to buy individual insurance was like buying a mattress, and there was no assurance, after purchasing a plan, that it would actually pay for all the costs that might result from a terrible accident or a devastating illness.