{"id":742,"date":"2013-11-12T21:35:00","date_gmt":"2013-11-12T21:35:00","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/2013\/11\/a-a-new-and-solid-floor-in-the-provision-of-health-care.html"},"modified":"2013-11-12T21:35:00","modified_gmt":"2013-11-12T21:35:00","slug":"a-a-new-and-solid-floor-in-the-provision-of-health-care","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/11\/a-a-new-and-solid-floor-in-the-provision-of-health-care.html","title":{"rendered":"A “a new and solid floor in the provision of health care”?"},"content":{"rendered":"\n<\/head>

That\u2019s what Eric Zorn, the Chicago Tribune columnist, is writing about in his blog today<\/a>: the notion that the GOP is \u201cstuck\u201d with ObamaCare because a true attempt at repeal will take away provisions that Americans like, as well as the buggy exchanges: <\/p>\n

the ability of children up to age 26 to stay on their parents\u2019 policies, the expansion of Medicaid to larger segments of the working poor, the end of the ability of insurance companies to take away coverage or declare lifetime reimbursement limits.<\/p><\/blockquote>\n

So let\u2019s dismantle this piece-by-piece (since you\u2019re all rather tired by now of my little essays on fatherless children). <\/p>\n

The ability of children up to age 26 to stay on their parents\u2019 policies? This is always cited as if, by some magic, it\u2019s free health insurance, but, of course, there\u2019s no reason why a 25-year-old \u201cchild\u201d is any cheaper to insure as a dependent than as an independent young person. (Maybe there\u2019s some reason why the administative costs are cheaper, in which case I don\u2019t see why an insurer would have any problem with a \u201cfamily plan\u201d.) But most of the time, this is a \u201cfreebie\u201d only in that employers haven\u2019t responded by changing their contribution structure so that rates vary based on the size of the family, but maintain their same ee, ee + spouse, ee + family structure, which means that the \u201cfree\u201d young adults are paid for by the company\u2019s workforce as part of the overall premium and, to the extent to which the employer\u2019s subsidy covers this, by lost pay raises (because pay and benefits are all a part of the same total compensation budget). <\/p>\n

Besides which, I just find it creepy and infantalizing to refer to \u201cchildren up to the age of 26.\u201d Yes, I know, we\u2019ve extended adolescence in so many other ways \u2014 education extending through graduate school, or young adults continuing to be supported by their parents as they work at unpaid internships, ever-increasing (in recent times, anyway) numbers of young people living at home rather than getting an apartment, delayed marriage, etc. But the fact that this is now a part of our vocabulary, these 26-year-old children, is unsettling, and I\u2019d be perfectly happy to get rid of this \u2014 neither to stand in the way of any employers or insurance providers who want to offer a \u201cfamily plan\u201d (any more than there\u2019s anything wrong with a T-mobile Family Plan), and even allow employers to provide the benefit tax-effecively, nor to mandate any specific age up to which coverage must be continued. <\/p>\n

The expansion of Medicaid? That\u2019s it\u2019s own separate question; the Medicaid issue is, to a fair degree, rather removed from the remainder of ObamaCare \u2014 since states have made individual decisions on whether to expand eligibility (and had previously had made individual decisions on how generous Medicaid should be in the first place). It\u2019s somewhat arbitrary whether Medicaid is provided up to 100% of poverty level or 133% or some other number, just as the poverty level figures themselves are arbitrary, as well as the fact that low-income cohabitors do much better than married couples because of the nature of how a \u201chousehold\u201d is defined.<\/p>\n

The end of the ability of insurance companies to take away coverage?\u00a0 Last I knew, the requirement that an insurer not rescind coverage upon a patient becoming ill, is not an ObamaCare provision but a longstanding issue.\u00a0 What\u2019s new, of course, is the \u201cno-pre-existing-condition\u201d requirement \u2014 and\u00a0here, really, the best way to avoid gaming the system\u00a0would have been\u00a0a mix of (what I believe Romney had proposed in his campaign materials) protection against pre-existing condition exclusions as long as you remain continuously insured (via employer-sponsored or private insurance \u2014 HIPAA had gone part of the way there but there were still gaps) and a one-time \u201cpre-existing condition amnesty.\u201d\u00a0 The very fact that the insurers are required to cover the already-sick at the same rates as the well is what produced the whole Rube Goldberg contraption with the mandates and other elements and the refrain that \u201cit\u2019s so carefully constructed that if you remove one element, it falls apart\u201d \u2014 not a very robust design.<\/p>\n

For that matter, if we had had a fully-individual market, there likely would have been some market response to this already \u2014 insurers offering \u201cfuture pre-existing condition\u201d protection as an add-on to standard health insurance policies.<\/p>\n

The elimination of lifetime benefit maximums?\u00a0 Actually, states have always had it in their power to regulate insurance (like Dorothy\u2019s ruby slippers), and nothing ever prevented them from requiring unlimited benefits, in the same way as Illinois has passed laws requiring IVF coverage, among other things.\u00a0 <\/p>\n

The bigger issue \u2014 and one that I\u2019ve not yet seen addressed with\u00a0careful attention to fact \u2014 is exactly what the cause is of the massive benefit increases that people are experiencing.\u00a0 I don\u2019t think that the throwaway line of \u201cthey had junk plans that hardly qualify as real insurance\u201d is true for most of these people; those who had the so-called \u201cmini-med\u201d plans knew it.\u00a0\u00a0My impression is that\u00a0what these plans were missing were things like the prescription drug coverage, the extensive coverage of \u201cpreventive\u201d treatments, the line items of maternity benefits and pediatric dental, even if the policy was for an adult male, and the like.\u00a0 It\u2019s also not clear to me to what degree the prices skyrocketed because of the new coverage provisions,\u00a0and to what extent the mandatory cross-subsidies (men subsidizing women,\u00a0the young\u00a0subsidizing the old, and most of all the well subsidizing the sick) as well as insurers\u2019 expectations of\u00a0disproportionate numbers of subsidy-takers,\u00a0are the driving force, which is just occurring simultaneous to everyone in the individual market being obliged to change plans to a \u201ccompliant\u201d plan and discovering the costs are now sky-high \u2014 in which case, the \u201cif you like your plan, you can keep it\u201d line is completely irrelevant; even if plans had nominally remained unchanged and thus \u201ckept,\u201d prices would still increase.\u00a0 <\/p>\n

But Zorn is right in one respect:\u00a0 the key element of ObamaCare is the subsidies, and ObamaCare has established a baseline which provides individuals subsidies to fund the purchase of health insurance.\u00a0 (The formulas are lousy \u2014 with major \u201cmarriage penalties\u201d and cliffs that act as strong incentives to understate your income, but it\u2019s a new baseline expectation nonetheless.)\u00a0 Any alternative which does not include monetary assistance towards the purchase of health insurance will not see the light of day.\u00a0 <\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

That\u2019s what Eric Zorn, the Chicago Tribune columnist, is writing about in his blog today: the notion that the GOP is \u201cstuck\u201d with ObamaCare because a true attempt at repeal will take away provisions that Americans like, as well as the buggy exchanges: the ability of children up to age 26 to stay on their […]<\/p>\n","protected":false},"author":2209,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-742","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nA "a new and solid floor in the provision of health care"?<\/title>\n<meta name=\"description\" content=\"That's what Eric Zorn, the Chicago Tribune columnist, is writing about in his blog today: the notion that the GOP is "stuck" with ObamaCare because a true\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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