The Flawed Logic of Repeal and Replace
The House Energy and Commerce Committee spent 27 hours debating Republicans’ Affordable Care Act (ACA) revision plan. During this time Pennsylvania Democratic Rep. Mike Doyle talked to local Republican Rep. John Shimkus regarding Shimkus’s objections to the ACA’s requirements for health-insurance plans. Unlike what has been traditionally available before ACA became law. ACA orders that all health plans cover certain essential health benefits, such as doctor visits, hospital care and prescription drugs. The law also requires plans to cover pregnancy and childbirth. These provisions seem to be an issue that created consternation with Shimkus in the Energy and Commerce Committee discussion.
“What mandate in the Obamacare bill does he take issue with?” Doyle asked Shimkus.
“What about men having to purchase prenatal care?” Shimkus replied.
As people in the room start to make audible sounds, Shimkus continues, “I’m just . . . is that not correct?” “And should they?”
The Shimkus question is a common one among opponents of the ACA.
Another famous exchange took place 2013 during another Energy and Commerce Committee meeting, when former Republican Rep. Renee L. Ellmers of North Carolina brought up the same thing with then Health and Human Services Secretary Kathleen Sebelius.
Referring to ACA's essential health benefits provisions Ellmers asked, “Do men not have to buy maternity coverage?” “To the best of your knowledge, has a man ever delivered a baby?”
Consumer Reports Senior Program Editor Nancy Metcalf answered a similar question from one of their reader that year:
Health insurance, like all insurance, works by pooling risks. The healthy subsidize the sick, who could be somebody else this year and you next year. Those risks include any kind of health care a person might need from birth to death — prenatal care through hospice. No individual is likely to need all of it, but we will all need some of it eventually.
So, as a middle-aged childless man you resent having to pay for maternity care or kids’ dental care. Shouldn’t turnabout be fair play? Shouldn’t pregnant women and kids be able to say, “Fine, but in that case why should we have to pay for your Viagra, or prostate cancer tests, or the heart attack and high blood pressure you are many times more likely to suffer from than we are?” Once you start down that road, it’s hard to know where to stop. If you slice and dice risks, eventually you don’t have a risk pool at all, and the whole idea of insurance falls apart….
Before the new health law took effect, insurers can and did exclude maternity coverage from individual plans. In fact, in half of states you can’t purchase maternity coverage on the individual market for any price. In most of the rest, you can buy a maternity rider on your policy. In many cases it costs more than the main policy itself, and you can’t use it for at least a year after you buy it, and it often has a separate deductible of up to $5,000.
Why so expensive? Because the only people who buy it are, naturally, people planning to have a baby. Insurers know this and price accordingly.
Using the logic of those that believe they shouldn't be required to ever pay for something they are convinced is not needed by them, if applied to all manner of other things, would wreak havoc on most of our infrastructure and institutions. How many people have heard the discussion about not having kids in school? Why should they pay? Because having well educated citizens is important if you are going to have a vibrant economy.
Healthcare discussion needs to focus on creating the best quality of life for everyone in a community. Does guaranteeing health care "access" followed by bankruptcy improve a community quality of life? Does removing well care benefits that reduce overall healthcare costs make sense? Imagine how many people will learn they have colon cancer at later stages because no screening is covered by their ACA replacement healthplan. Sorry, government said your insurer has no mandate to cover wellcare.
What sense does it make to remove the compensation caps of insurance executives that exist in the ACA?
It's our view that tweaking and improving the law already in place makes more sense than replacing it.
We'd love to hear yours.
