Maggie's Farm

To be completely fair, I don't think she got her job at Harvard by claiming NA ancestry. I do think she let Harvard burnish its diversity credentials by listing herself as faculty with NA heritage, when she should have known better or at least been more careful. And now she's simply ridiculous.

True. But I was following her academic career with interest back then, and she was a hot property, even though at the time no one had yet heard of this NA gene nonsense. It wasn't yet fashionable to pay much attention to it.

The ACA is obscure, but Congress understood it well enough to exempt itself from its effects. Yes, technically, Congress and its staff must go to the exchanges for health insurance coverage, but they got themselves declared a "small business" in order to escape that fate. With refreshing honesty, Congress argued that, if their staff were required to live with exchange policies, they would no longer be able to hire decent staff. I'd say that shows a strong grasp of how the law works.

Congress's original intent was to exempt itself from the exchanges, I agree--why wouldn't they? The exchange coverage sucks, and they knew it. Then they were shamed into making the ACA explicitly cover themselves as part of the ugly negotiations that got the law passed. They then escaped coverage by having HHS deem them a business, again because they understood that exchange coverage sucks. They also explained that they had to do this because they're competing to hire good staff, and intelligent people who make good staff know that exchange coverage sucks. What have I been telling you?

None of this would be too shocking if exchange coverage were designed to cover people who couldn't find coverage any other way. OK, it's last resort, maybe we live with the fact that we all know exchange coverage sucks. Unfortunately, the ACA was written to prohibit the continued issuance of pre-ACA-style policies to 3-5 million people in the individual market (such as self-employed people). Those of us in that category understood as well as Congress does that exchange coverage sucks and no one would accept it if they had any choice. Why do you think they took our previous coverage away? We could never have been forced to buy the bad exchange coverage if we'd been allowed to keep our existing coverage.

I'd have paid a mandate penalty if that had been all it took to keep my pre-ACA policy and tell the exchange to stuff it. The problem with the ACA was never just the mandate, which was easy to circumvent. It was the ACA's making the previous style of coverage illegal to issue and therefore unavailable on any terms, on or off the exchanges. The President and other leaders of the Dem party told us our pre-ACA plans would be grandfathered, though no new ones could ever again be issued. Even that was a lie. The grandfathering was a hoax. I have met exactly one person in 8 years who managed to keep her grandfathered coverage alive, by freezing it in amber. She can never change one jot or tittle about it for the rest of her life, if she wants to keep it. No switching to another provider network, no moving out of state, no slight modifications in the deductible, absolutely nothing. Above all, don't believe anyone from HHS or the carrier who assures you that a trivial change is not enough kill the grandfathering. They will wait until you take the bait and do it, but then the damage is irrevocable.

The price is risible, it's true, in part because they're legally prohibited from selling me the catastrophic coverage I want, the high-deductible kind that I used to rely on to keep my premiums down. The real price differential arises from the fact that I priced in my policy many years ago, paying for it continuously, before we both aged and developed more expensive problems. Now I share a price with people who didn't get insured until after they were expensively ill. It's like paying $100K a year for fire insurance because I'm priced together with people who wait until the firetrucks are on the way before buying a policy. In other words, my little sliver of the population, the 3-5MM in the individual market, are bearing the lion's share of the burden to subsidize people who did not get insured until they were already very sick. People on employer plans aren't sharing in this burden. Congress delayed the effective day of the ACA for them, and they remain blissfully unaware how things work for the self-employed.

(Part 2) But my biggest objection is not price. It is that in this county, and I am told now in all of Texas, it no longer is possible at any price to buy an ACA-qualified PPO in the individual market, only outstandingly crappy HMOs with ridiculous networks and more ridiculous hoops to jump through to get referrals to specialists. The coverage is not only unavailable for traveling outside Texas, it doesn't even cover expenses incurred outside this small county and immediate environs. That kind of insurance may come in handy for sniffles or flu shots, but it's useless for big, scary illnesses that could devastate my net worth if I have to go to a real doctor instead of some HMO network hack. The whole point of insurance should be to let me cover my ordinary bills out of pocket, then to kick in if I face something really unusual and expensive. This is the opposite.

(Part 3) Then there's the matter of having to switch every year. Carriers hate the financial instability of this system and steadily drop out of the market. You can never tell from one year to the next who might be offering a plan. Every year you start all over finding out who's in network at the last minute. Not that you can believe anything you find online or at the exchange about who's in network, certainly not before you choose your plan by the deadline. There is no official penalty when the carrier lies about who's in network; you have to call each doctor's office and personally confirm. And of course they routinely drop out mid-year as well. Since there is no choice (exactly two providers in the exchange in this county), there is no economic penalty either.

(Part 4) The rules for subsidies are arcane. The exchange personnel have no idea how to apply them. If you're self-insured and don't get a W-4 from an employer, or your income fluctuates from month to month or year to year, there is no way to persuade the HHS people that you've qualified for the coming year. No matter how often they agree on the phone or even on your "private" webpage that you have finally qualified, they'll keep sending you letters explaining that you didn't provide them with this or that (doesn't help to keep copies and return-mail certificates and receipts), so your subsidy is about to be terminated. Luckily, they generally don't mean it; a lot of meaningless paper apparently is generated and sent by robots. More often, they don't really dispute that you've sent a required document, they just explain that after several months they still haven't gotten around to reviewing it, or it's probably sitting in another office, and they have no idea how to find it. Then they will actually tell you that if they don't review it by the deadline, they're going to terminate the subsidy. It's Kafkaesque. Again, because there's no competition, they have nothing to fear by behaving this way. They're the only game in town. They are emphatically not worried about losing your business to the competition. Also again, if this were charity of a last-resort variety, these drawbacks might not be so shocking, but this is the only insurance I am now legally entitled to buy. It's not that I'll pay a penalty if I buy non-complying insurance, it's that the carriers were legally prohibited from selling it to me. The individual market was legally dismantled.



What's more, although price is not my primary concern, the new coverage costs three to five times what my pre-ACA coverage did, yet is supremely crappy in comparison. It's not that I used to drive a cheap Vega and they forced me to upgrade to an expensive Cadillac for my own good. It's that I used to drive a Cadillac at a price I could live with, but they confiscated it and ordered me to buy a Vega at five times the Cadillac price.

I love the argument that Congress was "unfairly singled out" when it forced itself to go into the exchanges. People like me were singled out and forced to go into the exchanges. Congress merely pretended to agree to go into them, for PR purposes, then used a loophole to renege, going right back to the Cadillac coverage they'd always enjoyed. The exchange structure they felt comfortable imposing on me wasn't nearly good enough for themselves, yet they lied even about that. "It's great stuff! We're going to use it ourselves! Um, not really, but you guys go ahead and enjoy it! Yes, we get to keep our plans, but you don't get to keep yours." Are you not even embarrassed to argue that of course Congress and its staff wanted good coverage and could never reasonably have been expected to submit to the crappy exchange coverage they were willing to force on others? Others who actually already had good coverage, which Congress was taking away? Because I mean this in the most respectful way: I didn't think even you could make an argument that hypocritical and incoherent.

You continue to evade the point. Congress agreed to go on the exchange plans as a PR stunt to show they wouldn't be so bad. Then they sneaked out, acknowledging how bad they were, but leaving self-employed people stuck there. You can talk until you're blue in the face about how it was a reasonable expectation for federal employees to have really nice insurance and never change this hypocritical lie.

As for the nonsense about how anything horrible about the ACA somehow can be attributed to the zero Republicans who voted for it, sell that dreck somewhere else. Have a little integrity, if you claim to support the law.

As for the idea that it's somehow OK that I used to have a PPO and now the exchanges offer only crummy HMOs, because PPOs are going out of style or some such nonsense, please. I was never in the tiniest danger of losing my PPO until Congress took my insurance away and stuck me in an exchange.

If people didn't buy insurance until they were expensively sick because they couldn't afford it, does it genuinely make sense to you to take away the insurance of the people who DID fit it into their budgets, and then make them pay for the people who didn't or couldn't? If that made sense to you as something the whole country might get together and do in order to spread the pain, does it really make sense to you to place that burden solely on the 3-5MM people in the self-employed individual market, while people on nice employer plans, including Congress, skate? Honestly I don't know where you come up with these silly desperate excuses. Have you no ability whatever to acknowledge when a mistake has been made?

True. And on further reflection, the emptiness of this creature's position could not be more clearly demonstrated than by the fact that he can uphold it only by discounting the reports of people with personal experience, while grasping frantically at the imaginary experience of others, who probably outnumber the real people who were hurt, because it just HAS to be true or else all is Chaos. Or by pretending that everyone expected the bad parts of the law all along, so why be surprised. Or by contending that Republicans magically caused all the bad parts to be written by psychic action at a great remove. Or by arguing that of course Congress lied about its willingness to subject itself to this garbage coverage, because who would expect such privileged people to settle for anything so substandard at such a ridiculous price? If a lie is transparent enough, isn't it almost like being honest?

All this after the law was originally justified because it would improve coverage and save money. Pathetic mental acrobatics. Well, at least it gutted the Democrat party. They may claw their way back, but for some years they were quite unable to inflict any more of their legislative wish list on us. The best they could do after 2010 was legislate by judicial fiat, and even that brought them Trump, Gorsuch, and Kavanaugh.

And indirectly, it put me into office, too.

Grandfathering was not merely flawed, it was almost universally unavailable. It may be true that a small percentage of total insured Americans lost coverage, but it is not true that a small percentage of those in the individual market did. Nearly everyone in the individual market did, yes, in the sense of losing the coverage they had in place and wanted to keep. Did they replace their coverage? Many did, but it was very, very crappy insurance and much more expensive. I have never met or even heard of anyone in the individual market who was not bitterly unhappy with the change. And there is zero evidence that more people were helped than hurt. You simply made that part up.