I don’t see an end in sight unless democrats cave and I firmly believe that they need to hold firm on their position. I don’t have a lot of confidence that they will because, they’re democrats and democrats don’t have backbones, political instincts, or the will to win for working people even if it means (like in this situation) keeping the gravy train going for private, for-profit insurance companies.
I posted the following on my FB page a few weeks ago to break down what democrats are really fighting for:
Secondly, understand that democrats are holding firm on one single piece of funding in order to allow the rest of the republican’s highway robbery of the working class to continue unabated: they want to maintain the premium subsidies for Obamacare. Have you stopped to think about that for a minute? Democrats are holding out for taxpayer money to keep flowing into the coffers of private insurance companies so that 15 million people don’t find themselves unable to afford the monthly cost of insurance, which includes a 20% “administrative cost”. Medicare’s administrative cost is 4%. IF ONLY democrats had a blueprint for a more cost effective way to deliver healthcare. OH RIGHT – Medicare, duh! Also, there’s the VA, which is even more efficient than Medicare. In fact, almost half of Americans are ALREADY covered by the Medicare, Medicaid VA combination: the least healthy half. I referred to Obamacare as a “better than nothing piece of crap” when it passed and I was right.
Well, I ended up doing a little digging after I wrote that post so let me share some details about the state of the ACA which I referred to as a piece of shit right before it passed. Before I can get to the current state, I have to back up and explain 2 key provisions in the original bill. The first provision subsidized premiums for households whose incomes were between 100% – 400% of the poverty line. For an individual, 400% was an income of about $43,000 a year and for a family of four, it was an income of $88,000 a year. As part of the American Rescue Plan Act, Biden increased the subsidies so that a family of three making $103,000 a year would qualify. That makes sense, because you can’t fucking afford to pay for health insurance in America if you’re feeding and housing three people on $103,000 a year. That expansion was supposed to expire in 2022 but Biden extended it for another three years so it’s going to expire at the end of this year.
This shutdown fight is about that expansion, not the original subsidies but I’m going to get back to the shutdown shortly.
The other significant provision in the ACA when it was passed, was a backstop guaranteeing that insurance companies wouldn’t take any losses on their plans in the exchange. That meant that if they had to pay out more claims than they had collected in premiums (plus their 20% “administrative” fee), taxpayer money would cover those losses. In 2014, little Marco Rubio inserted a poison pill into an omnibus spending bill that killed that backstop. Since insurance companies aren’t ever, ever going to lose a single dollar because that would defeat the whole purpose of their existence, this meant that those costs would manifest themselves in premium increases.
One more thing to remember about the original bill; it increased the length of pharmaceutical patents by 50% so instead of 8 year patents, they now get to charge a premium for their exclusive drugs for 12 years before a generic can be made available. This increases the cost of insurance, since insurance companies are paying higher prices for those drugs for 4 years longer.
Now back to the shutdown and the expansion of subsidies. The result of Biden’s expansion, which republicans want to kill is that we have nearly twice as many people receiving subsidies as we had in 2014 when the ACA went into full effect. When we talk about 15 million people losing their coverage because the steep premium increases will make it unaffordable, we’re mostly talking about the people who couldn’t afford coverage in 2014 because it was too expensive, but they didn’t qualify for any subsidies and then got insured in 2020 because they could get subsidies. In 2014, they made too much to qualify for subsidies, but not enough to actually afford to buy insurance. They have never made enough money to afford insurance. If you clicked on that first link I posted in this piece, you know that my beef with this piece of shit legislation is that it did nothing to actually bring down the cost of health insurance.
I fell down a rabbit hole of articles and data in an attempt to try and figure out what the exact impact of the ACA was on healthcare costs over the past week and I couldn’t do it. Covid really skewed everything. There were data sets that claimed that the ACA slowed the rate of increases and there were data sets that showed that the ACA doubled the rate of increases. Neither made sense to me and I ultimately concluded that covid made it impossible to get a clear picture.
Reason and logic tell me that there’s no way that the ACA slowed down premium increases, especially after I looked at earnings reports and stock price trends for the big 6 insurers. If you recall, all of the stock prices went up on the day the legislation was signed. We injected trillions of taxpayer dollars into this industry and did nothing to bring down actual costs. In fact, the big pharma patent extensions did the opposite.
If you’re as big a nerd as I am, and you’re interested in digging into some interesting facts about our health coverage as it compares to other countries, this data is really illuminating and will give you a pretty good idea of how to actually bring down costs.
So what’s my point here? It’s the same point I’ve been making for 15 years. We deserve better than this. This piece of shit bill that has done nothing but raise the cost of healthcare for everyone in the country is not what we need to be fighting for. Yes, we need to demand that democrats hold the line on this but funneling more and more taxpayer money to private corporations is not something that we should be applauding because at the end of the day, it’s the same pig that republicans have been raising for decades. Democrats just put some lipstick on it to fool you into embracing it.
You need to be vocal about not being willing to vote for any democrat who isn’t prepared to, on day one die on the Medicaid (it’s more comprehensive than Medicare) for all hill. We need to move everyone intoMedicaid and then turn Medicaid into a VA system that employs all of the doctors and negotiates with pharmaceutical companies. This is a much more efficient use of our resources than what we’re doing now, where we’re spending the most money on healthcare per capita and have the worst outcomes.
