I think this is where our civic philosophies differ.

My Insurance Experience

I, too, am not part of the ACA marketplace. I kept my prior insurance because I did not trust Congress to keep the ACA. I figured, if I kept my old policy, it wouldn’t evaporate anong with the ACA, leaving me an uninsurable person with a preexisting condition, when Congress repealed it.

I, too, saw my premiums rise every year of the ACA till I was paying $1000/month for health insurance for myself only. (My husband now is on Medicare and so has a different, much lower, supplemental plan.) Did I like this? No. But I was willing to suck it up for the sake of not having a lifetime limit and not being able to be excluded from coverage for a preexisting condition should I need to change plans.

Then, last fall I got a letter from my insurance company informing me that my policy no longer met the ACA guidelines. I would need to change plans. My heart sank. This was the trap I feared. I would have to go on a new ACA plan, the ACA would be repealed, and I would be screwed.

I phoned, and had a very helpful conversation with, an Anthem rep (high marks!). She walked me through the options and got me on a plan, available only to continuing customers, that met the ACA standards but was not part of the Healthcare Marketplace. (As it turns out, none of those plans available to me in Maine would work outside my state. Since I travel, how useful is that? Crazy.)

I now have a plan with an even higher deductible (by about 20%) but a lower premium (by about 30%). I did the math, and my maximum possible out-of-pocket expenses for a year have been reduced. My monthly expenses certainly have. So I have now seen a little improvement.

What I Really Want

What I really want is Medicare for all. My husband’s experience with Medicare has been great.

No matter what, I am going to be shelling out money for health insurance. What I want in return is service when I need it. I don’t care if that money goes to an insurance company or the government as long as I am guaranteed healthcare in a time of need.

A government program has the advantage of not having to make a profit. It would also have the advantage of being the biggest betting pool of all, and therefore, the greatest spread of risk. This should mean, mathematically, that we would get the same services for lower premiums. This makes sense to me.

But I think that is a bridge too far for Senator Collins, and she, as my representative, was the target of my address. Politics is the art of the possible. And I do think the ACA could be improved without being scrapped.

What Insurance Is

All insurance is a betting pool/distributed risk. A group of insured puts money in the pot based on estimated risk. Each of the insured is subsidising the others or not based on what tragedy may or may not befall. Everyone knows this going in. The insurance company is expected to skim a profit and they will if they have good actuarial data. Sometimes they screw up and lose big (chiefly in property insurance).

This is the deal, and it has been going on since the middle ages.

Why Health Insurance is Different

If you are uninsured and your house burns down, that’s sad, but it’s your problem. It’s also a very limited problem in that your house cost x, and you, after all, don’t need a house to live. You also don’t expect emergency contractors to rush in and rebuild it, only to have you shrug and say you can’t pay.

But hospitals and emergency services are obliged to do their best to save you from a health emergency whether or not you can pay. It’s the life of another human being. I have doctor friends who are very concerned for the financial viability of rural hospitals should the ACA be repealed. I hope you do not have to rely on one of their services if this is the case.

This is why I think everyone should be obligated to have health insurance. Insured people are already subsidising the uninsured through our medical bills and insurance premiums. This will not end unless everyone is insured.

Others

I feel an obligation to be my brother’s keeper. I know many people who are currently insured but will suffer greatly if the ACA is repealed. They will suffer physically in ways that will certainly lead to pain, disability, lack of productivity and, in some cases, a premature death. I, on the other hand, will only suffer financially. I cannot justify grousing on those terms. But that’s just me.