Even if the “mean” AHCA fails, we won’t have healthcare in 2018.

If you haven’t read about why Aetna is leaving a number of marketplaces, you need to.

“We have no intention of being in the market for 2018,” [Mark Bertolini, Aetna’s chairman and chief executive] said. He cited “the unclear nature of where regulation’s headed.”

This is not what a healthcare transaction looks like. Patients don’t pay clinicians directly. Even if you’re paying cash, you’re doing it at a counter after costs have been calculated and — generally — reduced, because the clinic isn’t trying to ensure the insurance adjustment won’t totally fuck them.

So anyway, by the time you’re reading this, Mitch McConnell will have put out his ultra secretive “we aren’t stupid” enough to tell you what’s in it healthcare bill. And there’s been plenty of punditry as to how, even if it passes the Senate, it won’t go through the House (thanks to the psychotic Freedom-from-the-things-government-is-supposed-to-provide Caucus). Well, okay. We’re good, right?

Not passing this bill isn’t going to stop the GOP’s crusade to kill the ACA.

Thanks to these people, we’ve never even seen the full ACA in the first place. Hell, look at the way they cut back exchange advertising — that was already placed and paid for — the second they took control of the executive branch.

And if, over the past 6 years, you saw your plan get shut down, or your premiums skyrocket, or your networks narrow, you can particularly thank Marco Rubio for making it happen.

Wait, aren’t risk corridors just a sop to insurers? Something something corporate Democrats?


Because here’s the thing. The insurance business model was literally “We only take care of healthy people.” If you were ill, they could instate lifetime caps (try needing surgery as a baby), extra-high premiums, or deny you coverage entirely.

And then the ACA was like, “Bitch please. You can’t charge sick people extra for premiums. Or deny them coverage ever, or after a certain point.”

So what happened was that people who’d been putting off necessary procedures signed up for a platinum-tier plan, getting those procedures, and then dropping off because paying the penalty was cheaper than those $3,000/month plans.

Instead of passing costs to hospitals — which cannot deny care to people who come through the ER— this system passed costs to the insurers. Which, because they didn’t get those risk corridor payouts, passed costs to you.

And these costs aren’t just higher premiums. They’re narrower networks. They’re the reason you can’t see your doctor anymore. Insurances are now required to offer a specific range of services — DME, maternity care, preventive care, et al — but they’ve been cutting back everything else.

In trump’s words, the House bill is “mean” and the Senate bill “needs a heart.” So maybe they won’t pass, big whoop. Trump has also repeatedly indicated that he’s going to let the ACA — which subsidizes insurance — implode just to score political points. And Mitch McConnell has claimed “gazillions of hearings” on the ACA as his excuse for holding 0 hearings on the Senate version of the AHCA.

As you’ve understood by now, especially if you read the linked article, this cannot continue, not if you’ve got any expectation of having insurance that provides reasonable coverage without insane premiums.

Enough is enough.

(Images from the public domain British Library and Wikimedia collections)

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