This week Trump met with the CEOs of all of the country’s major insurance companies, and boy was that photo-op indicative of the problem with Republican plans for healthcare’s future. It’s being decided on by predominately rich, white men—and rich, white men are the people least vulnerable if the Affordable Care Act were to vanish with no replacement, or a bad replacement. March is slated to be the month we know more, with Paul Ryan, Sean Spicer and Mitch McConnell all spending a lot of media time in February boasting grand, yet incredibly vague plans. And with insurance giants throwing their weight around—like Humana’s recently announced exit from 2018’s individual market as it stands—it’s certain that they have a seat at the negotiating table for what Trump Care will be.
On February 16th, House Republican Leaders, led by Paul Ryan, gave a press conference on ACA repeal, and for the most part avoided any mention of insurance carriers, which is a strategy that Republicans have used to pass all blame of expensive premiums and lack of choices onto the Affordable Care Act for years. The ACA perhaps didn’t require insurance companies to compete in all, or most states, and it didn’t accommodate for the money that would be spent on pre-existing conditions after its passage—but it’s the insurance carriers who decided to pull out of states or hike premiums. Those are independent decisions made by privatized companies. (Rate increases may need to be approved by states, but they’re still submitted by the insurance companies, and lobbied on at the state level). But Trump’s photo-op proved one thing for certain, the insurance carriers are very much involved. It seems they’re offering their two cents behind closed doors—which is dangerous.
Republicans have had a constant refrain through this most recent post-Trump repeal and replace push: less government involvement in healthcare. At the aforementioned press conference, Ryan spent a lot of time emphasizing this mantra. According to him, the government’s involvement at the center of the ACA is why there were “no options.” He also claimed that the ACA “restricts choice” and “denies competition,” two other falsehoods. Through this rhetoric, Ryan and his repeal cronies have cleverly branded what they will offer as “patient-designed,” hoping that people will follow the logic that if it won’t be government run, it will be patient-run. But that ignores the big, rich middle man: the insurance companies.
There is a version of healthcare that Republicans could introduce that would potentially allow patients to choose health insurance ad-ons based on their needs, like maternity or mental healthcare. And that would be a great step forward. But to bill it as “the patient and her doctor” deciding her health insurance needs, as he did, is a gross misleading of the pubic. First off, doctors aren’t insurance agents, and for the most part loathe insurance companies’ involvements, or better put, obstruction of care. In fact (and a pro tip in seeking affordable care if you lose your insurance) most doctor offices offer a discount when you pay in cash, because it helps them avoid tangling with an insurance company trying to deny your claim.
But even if doctors wanted to be involved in health insurance at a plan-constructing level, that rainbow-colored vision also entirely ignores the way insurance companies behaved before the ACA was passed. Insurance companies used to employ entire departments of people trained to comb through client’s medical records, social media accounts, anything they can get their hands on to prove that a patient’s new condition was actually pre-existing, and therefore deny their claim. Beyond that, things were (and still are) flagrantly miscoded often times, without a department double-checking. Even when claims were accepted, patients were still over-billed in complicated language, and unless they had a careful insurance agent, or did a lot of leg work on their own, it’s hard to get that bill recalculated or refunded, or even know if you were over charged.
For example, I went to the Emergency Room last year, and one of the bills I received was for $1,700. As I looked over it, I realized it said nothing in the field on whether or not the hospital I went to was in network—meaning they hadn’t even processed the bill according to my plan. When I called and pointed this out, the bill was run through my insurance properly, and re-priced to $85. The devastating fact though, is most people don’t know how to decipher an insurance bill, and would have assumed they had to pay the original amount.
Ryan also suggested a “fixed tax credit.” Under the ACA, tax credits are based on income-level and age. So everyone is getting a different, personalized amount of money from the government to pay for their coverage mostly based on their need-level income-wise. The fixed tax credit would be based only on age, according to the most recent reports. Assuming insurance companies are setting their own premiums—and let’s even say people are designing their own plans based on their needs—insurance would then cost more for sick people and women. We would essentially be fiscally rewarding genetics and privilege as those who are genetically predisposed to certain illnesses, or who don’t have access to affordable healthy food, or fitness, will be charged more. Women also will be charged more as the expenses of birth and pregnancy are astronomical. I don’t want to throw the word Nazi around lightly, and we are speaking in hypotheticals here, but if the above were to happen, it would be reminiscent of the Nazi eugenics ideals, however unintentional that may be.
Ultimately we will not know for a few more weeks what exactly will be implemented, and how, but the signs don’t bode well for the poor, sick, trans and female. Republican emphasis on more privatization, closed door meetings, spreading of misinformation, ACA-bashing, fixed tax credits, and pick and choose plans is scary. It’s painting a picture where the insurance companies have us all by puppet strings, with the government still throwing money at them, while not regulating them in any way. It doesn’t matter how many times they call that a patient-driven system; it’s not. Ultimately their anti-government cries are an obvious opposition to the democratic pipe dream of a single payer system, which frankly is inevitable. The question is how many people the government are going to let die in their last dice roll with privatized healthcare, and if they’re willing to turn our country into a genetic battle ground in the process.
Image: Sage Ross, CC-BY
Chloe Stillwell is a Nashville-based columnist focusing on politics, culture and feminism.