Yikes — what a legacy! In four years. Donald Trump bequeathed us dirtier water, filthier air, widening inequality, a legitimate mantle over “racist nationalists,” election deniers … But wait … Healthwise, there is more.
The ongoing Trumpian horror: junk insurance.
Fortunately, the Biden administration, much like a cleaning crew, is trying to mop this one up.
Our country has long had short-term plans, where enrollees gamble that all they need would be a few months’ coverage until they got a job, turned 65, got onto a spouse’s policy, or found the Fountain of Eternal Health. Often those premiums are low, as low as $30 a month. And often the plans do promise some protections. But generally there is a direct correlation: the lower the premium, the lower the coverage. So enrollees eager for the cheapest policy end up with the worst coverage. And to compound the misery, those cash-strapped enrollees often end up in emergency rooms, in surgical suites, in rehab units, where they discover not only how abysmal their policies are, but how voracious the “providers” are at collecting bills.
In 2016, when President Barack Obama, with major help from Speaker of the House Nancy Pelosi, launched the Affordable Care Act, the launchers recognized that the Act would not take effect instantly.
So President Obama allowed these plans to live for three more months, expecting people to sign up for the year-round comprehensive plans that covered preventive care, medications, hospital stays, and rehab. The Affordable Care Act, a.k.a. Obamacare, strived to cover as many Americans as possible with coverage that was not just comprehensive, but affordable, thanks to government subsidies. And the designers of Obamacare expected states to expand their Medicaid programs, again with subsidies. Sadly, some people did fall through “cracks” in the system; but the hope was to shrink those cracks, to insure most Americans for preventive care to keep them from getting sick, and and for the expensive inpatient care when they did get sick.
Enter President Trump, who vowed to kill Obamacare, to replace it with “something much better,” with the “much better” details to be announced. Fortunately President Trump and his allies did not kill Obamacare, but they did, in 2018, breathe life into the moribund short-term policies. They ruled: people could stay on those policies up to a year, and renew them for three years. The three years are coming up.
Recognizing the plans as “scams” that lured “suckers,” President Joe Biden is trying to clean up this remnant of Trump’s folly, (Reuters: “Biden’s Junk Fee Crusade Turns To Short-Term Health Insurance Plans”)
In the best of all worlds, this administration will soon inter this egregious remnant from the Trump tenure.
Predictably, though, at the same time, this administration must contend with a Republican nostalgia for the old days of useless policies that evade basic requirements — not just the short-term policies, but long-term ones that leave enrollees with little coverage and huge bills.
The buzzwords are familiar: self-insurance, association plans, giving employees money to buy their own policies. Consider the retro CHOICE Arrangement Act, for Custom Health Option and Individual Care Expense — more detritus from the country’s past decades.
The Affordable Care Act is not nirvana, but we risk returning to a past that left millions of American uninsured and underinsured.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.
From The Progressive Populist, September 1, 2023
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