OPINION

JOHN BRUMMETT: The post-Obamacare world

It is true and ironic that the House Republican replacement plan for Obamacare would seem to do harm to older working-class white people.

You see, it also is true, speaking in general terms, that older working-class white people delivered the presidency to Donald Trump.

Most likely, those Trump voters either don't believe they will be harmed--because they think the media and Democrats routinely lie to them to try to drive a wedge between them and their president--or they will say, oh, well, if that's so, then those are the breaks, because we can't go on this way in this country.


It might be instructive to reconstruct the essence of a conversation I had last year with a well-informed Arkansas man as I searched for, and tried to comprehend, Trump supporters.

The conversation basically went as follows:

Me--You say you are retired from retail management and in your early 60s, and that you are a live-in caregiver for an ailing relative. I can't help but wonder: What do you do for health insurance?

Trump supporter--Oh, I go on the Obamacare exchange and buy. The best I could find has a $720-a-month premium, which is ridiculous and unsustainable.

Me--Well, I hate to pry, but I'm assuming you have little to no ongoing income. You don't pay that $720, do you? You get a subsidy, right?

Trump supporter--Oh, yeah. I only pay a little more than a hundred dollars a month.

Me--Forgive me, but what, then, are you complaining about? You have excellent health insurance and the government is paying about $600 a month, or $7,200 a year, for you to get it.

Trump supporter--I'm complaining that it's outrageous that health insurance would cost that much, period. I'm saying the taxpayers can't afford it. I'm saying it costs that much because of the Obamacare mandates. I'm saying I ought to be able to buy something of my choosing in a free marketplace, something that covers less than the minimum gold standard of Obamacare, but on which I'm willing to take my chances. I'm saying the government shouldn't mandate that I drive a Mercedes that the taxpayers will make most of the payment for. I'm saying I should be free to buy a Ford compact.

Me--Are you saying that you want less insurance probably for more money out of your pocket than the $120 or so you're paying per month now for better insurance?

Trump supporter--Well, I'm not ready to admit it will cost more, or substantially more. The market will decide and grant me more options. And that's what health savings accounts are for. I've got a little money saved from my working days. I might be able to set up a small personal health savings account to cover the difference, if there is any.

That was it, except that I regret that I have forgotten what he said his deductible was, a key factor.

I believe, if I do say so myself, that the gentleman and I managed to compress the raging health-care debate into a few paragraphs about as effectively as anyone has.

At some point this debate comes down to arithmetic ... that and the quality of insurance, of course.

The man gets $7,200 a year, give or take, in a subsidy now under Obamacare. The Republican plan is to give him $4,000 for the year but allow him to buy something with spottier coverage.

Either way, he loses, but he's willing to lose breadth of coverage.

To be unharmed on premiums, he would need to find health insurance that would cost him the $120 a month he pays out-of-pocket now plus the $4,000-a-year, or $333 a month, the Republicans would credit him. He needs a premium of $453 a month.

Could he find something like that in a deregulated post-Obamacare world? Maybe, especially in Arkansas, where the delivery of a quarter-million Medicaid recipients to the marketplace through the private option holds down rates for everybody.

That's until the Republicans' planned Medicaid block grant takes effect in 2020 and jeopardizes the private option.

How high might his deductible be? Quite high. Thousands.

Co-pays? High again, compared to now.

How spotty might the coverage be? It would be very spotty, as you'd find if you really got in there and read the fine print.

He'd have something basically amounting to catastrophic coverage, though probably with a lifetime cap, which is to say coverage for a catastrophe up to a certain level of catastrophe. After that, he'd be on his own or dependent on the rest of us--as we all, inevitably, are.

We would really need for him to stay healthy those couple of years until he turns 65. That's when the ultimate best solution, government insurance, kicks in.

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John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, was inducted into the Arkansas Writers' Hall of Fame in 2014. Email him at [email protected]. Read his @johnbrummett Twitter feed.

Editorial on 03/14/2017

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