For all but nine months of my adult life, I have been one of the millions of U.S. residents who purchase health coverage directly from insurance companies, known as the individual health insurance market.
I did not have an employer that offered health insurance, nor did I qualify for any public programs. Because of this, I know what happens when pre-existing conditions like lifelong asthma become obstacles to getting coverage as an adult. I understand how insurance companies punish patients who commit the cardinal sin of actually using their coverage. I also know that “expanded choice” and “access” do not mean better health outcomes.
In the debate about health insurance, most of the discussion has focused on access and affordability. This was key to selling the Affordable Care Act (ACA), aka Obamacare. In their defense of the terrible, horrible, no good, very bad replacement called the American Health Care Act (AHCA), the GOP talking points also emphasize these crucial components. But if the House bill becomes law (the Senate has yet to unveil its version), 14 million Americans currently covered would lose access to health insurance in 2018 alone, according to the the Congressional Budget Office, many because it will be too costly.
Lost in the political noise is the real-world impact of an unfettered health insurance market for individuals. Today, as in 2009 when the ACA was passed, the majority of Americans receive their insurance through their employer. Prior to the ACA, those who weren’t seniors or very poor—who were eligible for Medicare or Medicaid—were at the mercy of private insurance companies.