Wednesday, March 01, 2017

"Where the hell are you?"

For the three or four people who may be wondering why I haven't blogged for a near a week: I've been taking testimony, so to speak, from a bunch of people who are buying unsubsidized health insurance in the individual market -- but who, thanks to pre-existing conditions, are more or less grateful for what they can get and worried about what the future may hold.

Some are members of of a political advocacy group here in North Jersey, whose tales I'm collecting for a story bank; others from Georgia Maine and Michigan as well as Jersey, have recounted their experiences for an article I hope to place elsewhere. In age they range from 20s to 60s. Because of their pre-existing conditions, or their propensities as people aware of risk, or their political sympathies, or all of the above, all are people who value insurance at its actual cost.

Virtually all of those who have been in the marketplace (or individual market) for some years have suffered premium increases, and out-of-pocket increases, and narrowing of networks, and in some cases, narrowing of choices. The collective picture of how the market's changed from 2014 to this year isn't pretty. And yet all are sensible of what the market was like, or will be like, without guaranteed issue and mandated comprehensive benefits.

Almost everyone I spoke to works. Most are self-employed -- a marketing professional, and IT contractor, an editor/translator, a veterinarian, a social worker, a book editor. They are, after all, earning enough not to qualify for subsidies. Some have kids, still young or adult, with pre-existing conditions, either on their own plans or on marketplace plans. They are for the most people conscious of their relative privilege, conscious of what the market was like pre-ACA, conscious of the cost and life-enabling necessity of medical care, and willing and able to pay - though some have spent a huge percentage of their income on healthcare, often for an extended run of years.

I cant' say they represent the nation. But then again, neither do Trump voters on Medicaid or other interesting, recently spotlighted segments of the population. They are an important part of the American story and a major subset of ACA beneficiaries.  After all, probably a third of those who sought coverage in the individual market pre-ACA either couldn't get it; a third of those who could get it were charged above-market rates; and another subset could only get coverage that excluded their pre-existing condition. The individual market did not work well for more than half of those who needed it. Today it remains a problematic market. But it's better than it was and serving about twice as many people. We should fix it, not destroy it.

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