February 3 2017
Since President Trump's election, proponents of the Affordable Care Act have made many frightening claims about what our health insurance system would look like should Trump and Congress fulfill their promise to repeal (and replace) it.
This isn't just a battle of political talking points. For some people, it is very personal. At Slate Magazine, Virginia Sole-Smith describes the heart-wrenching story of how her 3-year-old daughter, Violet, has already racked up nearly $3 million in medical bills. Violet was born with a serious, expensive condition: a single-ventricle heart.
I'm a new mom myself, and I can't imagine a hell on Earth worse than watching your child suffer. The story has a happy ending – Violet seems to be healthy now – but it raises important questions about insurance for sick children pre- or post-Obamacare.
I asked insurance expert and health savings account specialist Beverly Gossage to respond the article in Slate. The following is from Beverly:
First of all, let me say that Violet is adorable. Thank you for sharing her photo. I'm pleased that little Violet is doing better. Any child struggling with a health condition pulls at our heartstrings. I am pleased that she is able to receive top-of-the-line care and that you [Virginia Sole-Smith] and your husband bought health insurance for her.
Let me assure you that your employer plan will not be affected by repeal, except to give your husband's employer more options and more funds to pay better salaries since the employer won't have to pay outside administrators to help him process ACA paperwork and reporting.
You mentioned that your employer coverage offered unlimited lifetime benefits and dependent coverage until age 26. That's not surprising since most group carriers were offering unlimited benefits before the ACA and some states had dependent mandates up to age 30. Repealing the ACA returns the regulation to the states. If your state wants to keep these ACA provisions, it may do so. Carriers will likely continue these benefits voluntarily after repeal if these benefits are perceived to be popular. That's what competition does. You mentioned that you were concerned if your husband lost his job. That's understandable. That is why we advocate for more people to purchase affordable policies from the private market and delink coverage from the employer.
Imagine if your husband had been able to control all the health insurance dollars spent on premiums through the years (on average $17,322 per year according to Kaiser) to buy your family's private, portable plan before you started your family and before the ACA when rates were so much lower. You would not only have had a broad selection of plans at low prices, but thanks to the guarantee renewable law in place before the ACA, the carrier would have accepted Violet at standard rates, regardless of her health conditions, as long as she was added to your policy within 30 days of birth.
And the best news is the private carrier could not have raised your premiums nor dropped you due to Violet's claims. Plus, if you had chosen the popular HSA qualified option and funneled medical expenses through it, you would have received a tax deduction for all those medical claims. You would no longer have to worry about losing your husband's job as your policy would be decoupled from the employer. We want everyone to have this option.We all want to see children have access to quality health care and health insurance. Before the ACA, policies for children could be as low as $30 to $40. Under the ACA parents who had bought those plans found their child's policies were canceled and rates have jumped up to $200 this year.
With repeal, we can send regulation of private plans back to the states to repair the private competition that disrupted this market due to the ACA. All those little children that you are concerned about will have affordable options again. By the way, there are no GOP plans to discontinue the SCHIP or Medicaid programs for those for whom it was intended, namely low-income children and their caretakers, the elderly and the disabled.
Sadly, some states expanded Medicaid and took many able-bodied adults off of private plans and added them to the Medicaid rolls. This made it even more difficult for those who were intended to have this program to access care. We share your concern about doctors not taking Medicaid and children forced to have less than the best care. Fortunately, with a block grant, the states can do a better job of administering these programs more efficiently and even give those parents, who would rather have premium assistance to keep their children on their plan so that they can see better doctors, a choice.
Rest assured that Violet and other children have every opportunity to have even better access to affordable health insurance after repeal than they do now. That makes this mother of four, and grandmother of two, very happy. May Violet continue on a healthy path.