Exercise regularly for good health! (Photo by Robin Dale)

Can’t shake ‘em, I’ve got the Health Insurance Blues. Just when I thought it was safe to write a blog about writing, current events have revved me up (again) for the federal battle of the week.

It’s one more fight that I’m just not in the mood for, yet fight I do. I’ve called my representative. I’ve called my senators. I’ve called House Speaker Ryan for all the good that does. Why am I fighting? Because I am one of millions of self-employed people who purchases my health insurance through a state exchange, as established by the Affordable Care Act (ACA).

Let’s start with House Speaker Ryan. This boy genius has come up with the clever notion that a replacement plan for the ACA should charge older people more than ten times more in health insurance premiums than it charges young people. I am in the generic bundle of older, sicker people. With this I beg to differ. I work out 6 times a week, eat sensibly, maintain a healthy weight, have a flu shot every fall, don’t smoke and drink alcohol with such moderation that even my doctor says it’s okay. This is pretty much the way I’ve been conducting myself since my 39th birthday (18 years ago, for those of you who are keeping track). I rarely get sick. My most serious health problem is pollen allergies, which can be effectively treated with the restricted but reasonably priced pharmaceutical known as Allegra-D.

For as many years I’ve also paid for my own health insurance. The premiums have gone up with time. Just before the ACA went into effect my monthly premium for high-deductible coverage was $325/month. I’ve always chosen high-deductible coverage and have set aside savings over time to fill the gap, if one arises. The only year my premiums have been less than the insurance benefits received was 2004, when I had a diagnosis of breast cancer that was detected early, contained and easily treatable. My plan covered preventive screenings, including an annual mammogram which caught the problem and kept treatment costs low. In short, except for 2004, I “subsidized” others in the insurance pool for most of the years I purchased my own pre-ACA coverage. You don’t have to thank me, and I don’t begrudge you one bit.

Fast forward to the ACA. I have a bronze plan, the least expensive option available to me. Annual exams and preventive screenings/procedures are covered in full. I pay a little more than the rock-bottom plan for the additional benefit of 3 annual doctor visits with a $15 co-pay. After that, it’s my responsibility until the deductible is met. The monthly premium for this plan is $494; I pay $142. Yes, I’m one of “those people” whose income is more than 100% but less than 400% of the federal poverty level. The people in this group, in my opinion, receive the most benefit from the ACA. If I were in charge, I’d adjust the Advance Premium Tax Credit (APTC) to a greater multiple of the federal poverty level so middle-class individuals and families wouldn’t be hit so hard. Where should the APTC max out? Maybe at 800%? That’s something I don’t have the expertise to address, but some bright mind could certainly figure it out.

Back to House Speaker Ryan. His replacement plan for the ACA suggests that $14,000/year in health care premiums is appropriate for older, sicker people like me (can you hear my teeth gnashing?). Mind you, this group doesn’t include anyone old enough to qualify for Medicare. Under the replacement plan, it looks like those of us who are self-employed and between 50 and 65 would be the hardest hit.

Here’s an example. Right now, under the ACA, my total annual premium is $5,928 (what I pay plus the APTC). An annual premium of $14,000 is a 236% increase, and for what? I simply can’t afford it, even with the new proposed credit of $4,000 per old codger. Besides, if the replacement act passes I’ll be donating more to Planned Parenthood, whose annual exams and preventive screening services provided to the poor will no longer be reimbursed by the federal government.

What’s a realistic solution to America’s health care dilemma? After thinking long and hard, I’ve concluded we should:

  1. Build and reward a national culture that values healthy lifestyles.
  1. Develop a health care insurance system that covers everyone (including all federal elected officials) with the same benefits, for the same premium.

What I like about everyone getting the same benefits for the same premium is, it would give us an interest in making sure our friends and neighbors stayed healthy. Why? Because the premium would have the flexibility to go up or down, based on how well we did as a group.

Kind of like we were all citizens of the same nation.

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