Psychiatrist, Advocate for Patient Care

Beecher Musings and Writings

March 3, 2017 - Star Tribune

AFFORDABLE CARE ACT

In ‘repeal/replace’ era, what is health care insurance, anyway?

As we move into Affordable Care Act “repeal and replace” discussions and action, consider Obamacare’s fundamental philosophical and economic paradoxes.

On one hand, the ACA law is a boon to establishing government-insurance company cartels taking federal and state government money to “cover” U.S. citizens who are not enrolled in Medicare, Medicaid and the VA. Also, of course, the large ACA Medicaid expansion in Minnesota is administered through HMOs in cartel arrangements with our state government.

But what is the fundamental definition of heath care insurance, anyway? The ACA flatly negates the principles of individual patient insurance risk underwriting by requiring “guaranteed issue” and removing all “preexisting conditions” as coverage exclusions. So now, health care insurance companies must enroll all applicants based not on the likelihood of their incurring projected health care expenses but rather based on their social status as defined by government-income thresholds. Therefore, it’s no surprise that insurance companies have dropped out of MNsure and the Minnesota individual insurance market. We must continue to pay off the insurance companies unless we have proper definitions of health care insurance distinct from social health care entitlements.

2017? This year, the Minnesota Legislature decided to subsidize insurance companies that cover Minnesotans faced with huge increases in their health care premiums. There are current proposals to re-establish a Minnesota high-risk pool to be administered internally within Minnesota insurance companies. This will allow them to unload expensive cases to taxpayers.

I’m thinking we should bring back a patient-centered high-risk health care insurance pool in Minnesota modeled after the 1976 Minnesota Comprehensive Health Association plan (http://mchamn.com), which was phased out in 2013 because the ACA was supposed to be a refuge and safety net for patients and families with expensive medical conditions.

Dr. Lee Beecher, Maple Grove