The Nice Guy Finished Last / First

Robby is the nicest guy I know. No exaggeration. Robby is just a great guy. And right now Robby is losing and winning the health insurance battle.

Robby was referred to me by his employer at the very beginning of the full rollout of the Patient Protection and Affordable Care Act (Obamacare). So I have never asked him any health questions, but I have no reason to believe that he has any medical issues or ongoing prescriptions. He is just a laborer, single and a non-smoker, in his early 50’s, living in Parma. There are thousands of guys just like him throughout Greater Cleveland.

Robby has gone years without health insurance. His employers seldom provided coverage and he couldn’t possibly afford it on his own. The PPACA guaranteed access to coverage AND included a penalty for non-compliance. The penalty was an important factor in his request. It would be unthinkable for Robby to jaywalk, he certainly wasn’t going to do anything penalized by law.

And Robby got a policy. It was a terrible policy with a $6,000 deductible and it cost him $110 a month after his tax credit subsidy of $187, but he was covered and if, G-d forbid, he got really sick or injured he would have easy access to world-class facilities right here in Cleveland. He even got a free routine annual exam, if he ever had a chance to get to a clinic on a day he wasn’t working. So, Robby won. We all did. We had one less uninsured American worried about a major illness and a society less concerned with the inevitable bill for his care.

Robby’s insurance went up $30 a month beginning January 1, 2015. Robby’s victory wasn’t quite so sweet.

The price of insurance was going up. The subsidies were going down even though his income had hardly changed. The invasion of low-cost Medicaid providers into the Exchange severely impacted Robby’s subsidy. If he would allow the Exchange to force him to Metro and Charity hospitals he would pay less. He hung on to the Cleveland Clinic and the price went up to over $250 with his subsidy for 2016.

In 2017 his premium is $325 and his deductible is $6,400. Robby is losing.

I got a call today from Robby. He wants to drop his policy now that he is no longer required to keep it. I let him know that he can drop the policy but that he would still be liable for the penalty. He thought that it was over. I had to break the news to him that the individual mandate, both a Republican idea traceable to the Heritage Foundation in 1989 and Republican strawman, was still the law.

President Trump’s Executive Order gives the Secretary of Health and Human Services and other department heads the ability to reduce the “burden” of complying with Obamacare. Congressman Price’s confirmation for Health and Human Services has been stalled due to what appears to be insider trading. More importantly, the insurance companies are scared to death of adverse selection. Without the individual mandate, the only people who will buy insurance are the sick and the responsible. That could be disastrous.

With no immediate viable replacement, a nice guy like Robby has no place to go. He’s winning. He’s losing. Nothing has really changed.

DAVE

www.cunixinsurance.com