The "Radical Seed" of Single-Payer

November 3, 2016

**To receive this weekly commentary directly in your email, CLICK HERE.


I want to change people’s minds. Let me start with this: The Affordable Care Act ended health insurance in America. The cost of this decision is now front-page news. The ACA’s ban on affordable catastrophic insurance and its ban on pre-existing condition (“pre-ex”) exclusions means we don’t have health insurance any more. The ACA mandates that health plans enroll people with pre-existing conditions. That’s not insurance against a risk. That’s third-party financing of a known condition.
The law also equalizes premiums for healthy enrollees and unhealthy enrollees. Both must be charged the same, regardless of health status. That’s not insurance either.
Skyrocketing costs are the result. People with pre-existing conditions—most of them previously insured through the 35 state high-risk pools disallowed by the ACA—entered the Obamacare exchanges in droves, driving up costs and premiums for everyone buying insurance on their own. This is because a policy sold off the exchange must be the same price as a policy sold on the exchange.
Bottom line: This means the cost of people with pre-existing conditions was shoved onto the small segment of Americans that buy their own coverage. The exchange essentially became the federal “high-risk pool” for people with pre-existing conditions—funded by the approximately 11 million Americans who buy their own insurance without subsidies on or off the exchange.
Meanwhile, nearly 83 percent of all exchange enrollees get subsidies funded by taxpayers, who must also pay the higher premiums. NOTE: Most people with employer coverage are sheltered from skyrocketing costs because they’re not in the exchange and don’t buy their own coverage.
Democrats tried to hide the cost of this plan. To prevent health plans from increasing premiums to cover “pre-ex enrollees,” the plans were promised risk-based subsidies for the first three years -- the length of time expected for the young and healthy to enroll and their premiums to cover the increase. But the subsidies were insufficient and most Millennials wisely stayed out. Moreover, most businesses decided to keep their employees off the exchange.
So today, with two of the law’s risk-based subsidies disappearing on December 31, the cost of the law’s “pre-ex ban,” low enrollment, ban on catastrophic coverage, and rich benefit requirements is showing up as 25 to 145 percent premium increases for individuals, families and small businesses.
I once heard the liberal Van Jones discuss how a “minimum demand”—something small and seemingly insignificant—could be a “radical seed.” I consider the ban on pre-existing condition exclusions the radical seed of single-payer. Where health insurance ends, national health care begins. (Search “radical seed” in this 2010 Glenn Beck transcript)
Ask almost anyone on the Left and the Right and they’ll tell you they support banning health plans from refusing to cover people with pre-existing conditions. I want to change their minds.
We’re not stuck in single-payer yet. It’s time for solutions and legislation that revive true insurance (affordable, major-medical) and advance life-long, portable, personally-owned insurance that ends the risk of “pre-existing conditions” for future Americans and provides workers with job mobility unrelated to medical conditions. If Congress doesn’t take action, states should reassert 10th Amendment rights to re-establish catastrophic insurance, state risk pools, and more.
The Left desperately wants today’s calamity to end in single-payer.
Let’s make sure that never happens.
For freedom,
Twila Brase, RN, PHN
President and Co-founder