Over the next few weeks you are going to hear a lot of right wing talking heads spout off about ensuring “access to health insurance” in whatever plan they happen to be promoting at the time. However, access to health insurance is not the same thing as being able to obtain health insurance.
Bear with a thought exercise for a moment. Everyone in the United States has access to a Chevrolet Corvette. However, only a small percentage of the population of the United States can actually afford a Chevrolet Corvette. Access does not equal the ability to obtain.
The example is facetious and it does not go far enough. No one needs a Chevrolet Corvette for transportation when a Chevrolet Sonic will do just fine in most cases. Yes, it is a completely different car but it provides basic transportation. Again, a large segment of the population cannot obtain a Chevrolet Sonic even though they have access.
Prior to the passage of the Affordable Care Act millions of Americans were denied access to health care based on pre-existing conditions. Now, Republicans are likely to not totally scrap the prohibition of denial based on pre-existing conditions but it is likely to be modified in a way that benefits health insurance companies in denying you coverage. Therefore, Republicans will have preserved “access to health insurance.” See, they are looking out for the little guy. Aren’t you relieved?
Beyond accessibility is the issue of affordability. Under the current system, which again is defined by the Affordable Care Act, health insurance for lower income individuals is subsidized. Makes less money and you qualify for a larger subsidy. According to Republican logic this is evil.
Under Republican plans the current menu of subsidies would disappear and be replaced with…you got it, tax credits. These tax credits are not based on income, but age so even if you are rich you get the same tax credit as someone who is poor. Furthermore, these tax credits will do nothing for the segment of the population that cannot afford health insurance and does not pay taxes because they make too little income.
Make no mistake that the right wing of the right wing, known to most in Washington D.C. as the so-called “Freedom Caucus,” will probably support none of this tax credit nonsense. The reasoning will be a word salad including the terms “socialism, communism, fascism, Obama, market based solutions, capitalism, Ronald Reagan, America, freedom, and Jesus.” You can feel free to rearrange the words to match whatever particular politician from the Republican Party happens to be speaking.
In practice this means that whatever mechanism to ensure affordability that survives the gauntlet of Ted Cruz and Rand Paul will likely be so meaningless as to make health insurance as unaffordable as it was prior to the Affordable Care Act. Therefore, “access to health insurance” has been limited because affordability is central to accessibility. Do not fall for this madness.
Under Republican plans prices for plans will go up, the ability of health insurance companies to screw you over will increase, and the ability of people to actually afford health insurance will erode considerably. However, you will have “access to health insurance” and that should make you feel all warm inside as you read that dog eared copy of Atlas Shrugged.