ACA Repeal: Healthcare and Ideology

Photo Courtesy of Holden Police Department

Texas Congressman found a blunt way to describe what “repeal” is really about.

“We’re not going to send an IRS agent out to chase you down and make you buy health insurance,” said Representative Michael Burgess, a Texas Republican who’s a medical doctor and head of the House Energy and Commerce subcommittee on health. “If the numbers [of people with health insurance] drop, I would say that’s a good thing, because we’ve restored personal liberty in this country.”(1)

 It’s liberty for people who can afford to pay out-of-pocket for their medical expenses or buy concierge care.  That’s basically the 1%ers. It’s not liberty for anyone else.

Concierge care is an annual retainer or contract between an individual and a physician.  It’s been likened to a membership.  In return, the individual gets some services for no additional fee, including services that might not be covered by insurance.(2)  Some medical practices charge fees as low as $15 per month; some charge upwards of $10,000 per year — and that’s on top of health insurance and other costs you might pay out-of-pocket.  The wealthy have been annoyed at the tax penalty for not having health insurance when in fact they don’t use standard American health insurance.  The penalty isn’t large enough to be meaningful for someone making upwards of $300,000 per year, to the resistance is based on ideology or “principle” rather than practical economics.

Unfortunately, allowing healthy people to drop out of the insurance risk pool raises the price of health insurance for everyone else.  The rich will not have standard health insurance.  Healthy 20-somethings will drop coverage for cost reasons.  The cost of insurance claims will not go down, so that cost will be borne by a smaller number of people.  It’s simple math.  That’s why the insurance industry expects rates to go up by between 15% and 20%, and the non-partisan Congressional Budget Office sees health insurance rates climbing by as much as 25%.

The other ideas being floated this week include:

  • Basing insurance subsidies on age rather than income or need.  That would allow affluent consumers to get subsidies while younger families might not be able to afford it.
  • Elimination of subsidies altogether.
  • Taxing employer-provided health insurance.
  • Excluding coverage for people with pre-existing conditions, or creation of “risk pools” for these individuals.  The risk pool idea was tried in both auto and health insurance and failed in both cases.  Financing didn’t work and the policies became absurdly expensive for consumers.

The following administrative changes are being put into place:

  • Reducing the length of the open enrollment period to 6 weeks (1 November to 15 December).  In 2017, consumers had until 31 January to enroll.
  • Greater scrutiny of “special enrollments.” Consumer had been allowed to get coverage in the Marketplace when work or personal situations changed.  Now they will have to provide evidence to justify a special enrollment.  That will make the process longer and more cumbersome.

Former Speaker of the House, John Boehner, is quoted as saying there will be no repeal of the ACA.

“They’ll fix the flaws and put a more conservative box around it,” Boehner said. “The framework is going to stay there.”(1)

If so, that would be a response to an upswell in public support for the ACA.  54% of Americans now say they support the act, and that’s the highest level of support since the law was passed in 2010.

The new survey finds that when those who disapprove of the law are asked about what should happen to it now, more want GOP congressional leaders to focus their efforts on modifying the law than on getting rid of it. One-in-four adults want Republican leaders to modify the law, while 17% want them to get rid of it entirely.(4)

We’ll see. One Congressional leader is promising ACA legislation in March, but the GOP remains divided on what to do. Further, they promised legislation would be introduced in January. It’s not clear that they are any closer to a bill now than they were then.

As more information emerges, I’ll keep you posted.

What you need to consider:

If you’re concerned about the rising cost of healthcare or whether you will even have it next year, you may want to let your congressman know.  We’re 18-months from the next election, and this would be a good time to let your congressman know that you care and you vote.


  1. Billy House, Zachary Tracer and Anna Edney, “GOP ACA plan would cover fewer people; blowback grows,” Benefits Pro Magazine, 24 February 2017.
  2. Lisa Gerstner, “6 Things to Know About Concierge Medicine,” Kiplinger Newsletter, 31 August 2012.
  3. Advisory Board, “What is Concierge Care?” 8 July 2014.
  4. Hannah Fingerhut, “Support for 2010 health care law reaches new high,” Pew Research Center, 23 February 2017.
  5. Congressional Budget Office, “How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums,” 17 January 2017.
  6. Consumer Reports, “Repair, Replace, Repeal: What’s Really Happening With the ACA,” 17 February 2017.


    • It doesn’t have to be that way, but we need to hold politicians accountable for what they do. Congress actually created most of the major issues we have with pharma and insurance.

      With pharma: blocking Medicare from negotiating drug prices; creating a special “exclusivity” license to manufacture a drug that goes beyond the normal patent period, and blocking Americans from buying identical drugs from the same manufacturers from Canada, where the drugs are much cheaper. Gouging Americans is supposed to incent drug companies to do more R&D, although less than 10% of their enormous profits are reinvested in research.

      With insurance: the Supreme Court gave the Federal government the right to regulate insurance, and a Republican Congress gave control back to the states in 1948. That’s why we have fragmented markets and limited competition. It all keeps rates higher than they would be if there were free competition. Then we have the unwillingness to use antitrust laws to keep markets competitive.

      No Congress is the root of these problems. The companies are simply taking advantage of what Congress let’s them do.


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