Obamacare has been controversial since the first spittle-flecked angry debates began. Now that Congress is making an attempt to repeal it that might actually succeed – especially since they have done exactly nothing to replace it – it might be a good time to look at what they’re so eagerly yanking away.
What Obamacare Is, And What Obamacare Also Is
First off, the Affordable Care Act (also called the ACA and also also called the Patient Protection and Affordable Care act, or PPACA) is Obamacare. Obamacare is the ACA, even though there seem to be people who refuse to believe that the two are the same.
If you currently have coverage through the Affordable Care Act, you have an Obamacare plan. A significant portion of the United States population doesn’t know that. If you’re on a plan through a state exchange like Covered California or Your Health Idaho or One, Mississipi, you have an Obamacare plan. Lots of people don’t know that either.
If you weren’t aware if that, there’s no shame in it, but you need to think about expanding your news sources. Because some politicians and “news” sources have deliberately muddied the waters for you. And they did so in a way that could have put family’s health at risk in order to score political points. That is vile. Can we agree that it’s vile? Let’s at least agree on that.
Marketing Can Make You Sick
Even if you were aware that Obamacare and the ACA and state exchanges are all the same thing, this is an important point because the use of the name “Obamacare” is one of the great successes in Evil Marketing of our generation. Republicans didn’t want a national health care plan to succeed because they didn’t want anything put forth by President Obama to succeed. They started using the term “Obamacare” because they knew that it would get knee-jerk Democrat haters and knee-jerk Obama haters and, let’s face it, no small amount of racists to oppose the plan, even if it was very much in their own interests to have it pass.
To be clear: The Republicans adopted the term “Obamacare” to get people to oppose their own potential life-saving cancer treatments. I don’t care what side you’re on: That’s some coldblooded reasoning.
It was also insane because Obamacare is a Republican’s wet dream.
The Great Big “Socialist” Republican Plan
Let’s remember that Obamacare was Romneycare first. The newly elected President Obama adopted it as an idea because there was this weird six- or eight-month period right after he took office where he seemed to think that Republicans might actually work with him to make the nation a better place instead of dangling from ropes and claiming they were floating if Obama mentioned a belief in gravity. If Obama had endorsed oxygen, Republicans would be trying to breathe sulfur right now. (Which is actually not far off from their environmental policies.)
As you might expect from a Republican plan, WHICH IS WHAT OBAMACARE WAS, the ACA was a huge giveaway to giant private companies. The coverage mandate drove private citizens’ money to insurance companies and the subsidies shoveled government money to private companies. Since driving all the money up the ladder to large corporations is pretty much the only principle the GOP has left (other than Lock Down the Uteruses and Get Those Gays Back in That Closet), they should have been fainting with joy at the idea of passing it.
The ACA could have been a huge win-win: Millions of people would get access to health care (Democrat win!) and a bunch of private companies would have gotten new customers (Republican win!). But since Obama Jedi-tricked them by saying he liked it, the Republicans couldn’t say they liked it anymore. Yes, this is the same way an older sibling can trick a four-year-old into not eating a cookie. Welcome to the current age of political posturing.
Here’s the other part of the ACA fight that the news reported much less well: Even though this was a huge gift to insurance companies in the form of mandated customers, health insurance companies did not want the gift.
Some of them pretended to want the gift – some even stepped in to “help design” Obamacare, as you certainly would too if you could affect a law that might send you millions of dollars – and some companies were publicly on the fence, but most also quietly threw millions of dollars at defeating the ACA through America’s Health Insurance Plans.
Why would they do this? If you learn nothing else from this article, learn this: There is nothing health insurance executives hate and fear more than sick children.
I know this because I worked in the health insurance industry when the whole Obamacare debate was going down and during the first few years of its implementation.
I was by no means an executive; just a peon in marketing helping to make the brochures and explain the plans and benefits. But I was in plenty of meetings where I heard executives root against the ACA passing – the higher up the chain, the harder the rooting – and when it did pass, I watched them maneuver, scramble, and claw to escape the terror of sick children.
Here’s a quick primer:
Health Insurance Is Legalized Gambling and Your Insurance Company Is the House.
The business model of a health insurance company is to take in more money in payments than they give out in benefits. They jigger their odds by adjusting how much “risk” they take on.
As a rule, you can get the most affordable insurance through a group health insurance plan in part because a large company (or union or church) can negotiate, but also in part because the insurance company assumes that a large group will have enough young/healthy people paying in to offset the risk of older/less healthy members. Anyone over 65, of course, has massive financial incentives to move over to Medicare, so nobody on your group plan is going to be all that old.
All of this used to mean that if you had ever had cancer or any other kind of pre-existing condition, you needed to be on a group insurance plan where you’d get offset by Ayden, the 23-year-old stockboy. If you were on an individual, single-family, or small business plan, the insurance company saw you as a walking bundle of risk and would either make you pay out the nose or do everything it could to avoid insuring you. (Or both.)
Even now and even within a group plan, you’re doing some gambling.
You have to guess how much you and your family will need to use your insurance. As a rule of thumb, you can pay high monthly premiums for a copayment plan in exchange for knowing that you’ll pay set, smaller amounts for regular care and you (probably) won’t take too enormous a hit if you have a serious illness or injury. (Though medical bankruptcy is still very much a possibility. See below.)
Getting a copayment plan, though, depends on being able to make those high monthly premiums, which a large chunk of middle-class customers can’t do. That’s why they move over to the roulette table of deductible plans. With a deductible plan, you pay lower premiums and hope real hard that you won’t actually rack up the $3,000 (or $5,000 or $25,000) in costs that you have to pay out-of-pocket before your insurance company starts paying.
As you’ve noticed if you have one, a high-deductible plan is a lot like not having insurance at all, at least in terms of the potential to get wiped out by medical costs. The advantages of having a high-deductible plan are that you can get basic preventive care and that you can say you have health insurance.
The business model of any health insurance company is to lower its risk.
- Take in as much money as possible in premiums.
- Skew your customer base to young, healthy people who won’t use their insurance.
- If they do use it, find reasons to avoid paying out.
And just like casinos will toss out a skilled card-counter, insurance companies used to throw out anybody who got big or regular payouts.
I hate to break this to you, but as a business, your health insurance company does not care about your health except in the sense that healthy people tend to use their insurance benefits less. Remember a few years ago when all the insurance companies got all warm and fuzzy about preventive care? It wasn’t because they loved you. It’s because proper preventive care keeps their costs down, and they noticed that.
If you want an entity with a primary mission of keeping people healthy, you might want to look at something like, oh, a national plan like Medicare. Your insurance company is a business, and its primary mission is to make money.
People think of the ACA as something that got health insurance for millions more people – and that is a true thing and a good thing. But just as important was an aspect that was incredibly under-emphasized:
The Affordable Care Act Stopped Your Insurance Company from Doing Some Truly Awful Things
I say “your insurance company” because all these horrible things were industry standard:
- Refusing to cover people with pre-existing conditions or pricing plans out of their reach
- Charging women more for insurance because of their scary reproductive systems
- Lifetime and yearly limits on care
Hey, let’s look at that last one!
We need to remember it because it used to come into play all the time before the ACA passed: Someone with expensive medical treatments – cancer treatments, for example – would hit their limit and that would be it. The insurance company would stop paying for treatment. And, as someone with an expensive pre-existing condition, they would be uninsurable anywhere else.
Once you were dropped, the choice was whether to die or bankrupt your family. Or to bankrupt your family and then die. And lest you think that choice was restricted to people who had already led rich, full lives, I will remind you that kids get cancer. Children sometimes require feeding tubes. Imagine being told that your son is approaching his lifetime limit, so you’d better hustle up a few million or he is literally going to starve to death.
(For those of you who just launched into a speech about how we should rely on our communities for care in those situations, please think about who in your community is qualified to deliver chemotherapy or insert a feeding tube. Too literal? For how many months in a row can your church raise thousands of dollars?)
This example is why insurance companies are terrified of sick children: Sick children sometimes stay sick for a very long time and it tends to make the news when you abruptly cut off their life-sustaining medical care.
And it’s true: From the point of view of an insurance company, if you don’t think about precious human life, it isn’t fair: The company might have to hand over huge amounts of money to one patient indefinitely. Businesses hate that, and for good reason.
It’s almost like we should have some sort of national single-payer health care program.
While we’re on the subject of lifetime financial caps:
NO, THERE WERE NEVER ANY DEATH PANELS IN OBAMACARE.
Never, not even for a moment, not even in an early draft. This is one of the most despicable lies that was spread during the whole process.
Here’s what was in the bill:
If you were terminally ill, potentially terminally ill, or just getting on in years, the ACA spelled out a way to have a frank discussion with your doctor about your needs and wishes.
- What you could expect about the progress of your illness.
- What your treatment options were, and how they would affect you.
- Whether you wanted hospice care.
- Whether you wanted heroic lifesaving measures, and what kind.
- Whether there were specific procedures you didn’t want.
In other words, you would have the comfort of knowing what was happening and having control over how you handled it. And your loved ones would at least have the comfort of being sure that they were following your wishes.
Anyone who has dealt with terminal illness knows that such a conversation can be a godsend.
If your news organization or elected representative portrayed this necessary and comforting provision as something that allowed soulless government bureaucrats to turn off Grandma’s life support, you were lied to, and cruelly. Anyone who lied to you about this was willing to make your life more difficult at an already excruciating time just to score short-term political points. So it might be time to re-think your news organization or elected representative.
But wait, didn’t you just read something up there about cutting off care?
Yes. Insurance companies used to do that very thing with lifetime caps. Death panels were already there. It’s just that they were made up of insurance executives. Does that sound comforting?
Obamacare did not start government death panels. It did stop insurance company death panels.
If you don’t want lifetime coverage caps to come back, the time to call your elected representatives is now.
One more reason to love ACA regulations:
Obamacare requires insurance companies to use clear and simple language in their documents.
This means that you can currently:
- Understand what you are and aren’t getting from a plan.
- Compare plans easily, even between companies.
- Know what you’re signing.
- Know what rights you have.
Fun Health Insurance Company Story Time!
Once, before the ACA, I was editing an extensive individual insurance application form. There was an arbitration agreement page that the applicant had to sign if they wanted coverage. Essentially the arbitration agreement said that if the HMO screwed up, the applicant couldn’t sue in a real court.
The agreement was a mess – paragraphs of convoluted legal language, bizarre structure, and unnecessary three-dollar words. I spent more than a full work day editing it, making it into a clear document that the average reader could understand.
It came back with all my changes rejected and a note sent from above via the project manager to explain why: “We don’t want them to know what they’re signing.”
The Affordable Care Act stops companies from doing that.
If you don’t want insurance companies to be able to deliberately confuse and mislead you, the time to call your representatives is now.
Fun fact: Obamacare has some other popular aspects, like allowing children to stay on their parents’ plan until age 26 and requiring companies to spend at least 85% of the money they take in on patient care (as opposed to, say, executive salaries or advertising). If the ACA goes away, those things go with it.
Let’s Get Back to Those Sick Children
As we’ve seen, insurance executives fear sick children because they have the potential to be very expensive for a very long time.
Another thing you should know is that parents who aren’t on group plans and are struggling financially – often middle-class families – tend to insure just the kids, because most parents will take risks with their own health that they won’t take with the health of their children.
When Obamacare started to look like it would pass, insurance companies lost their minds. Without pre-existing conditions, it would be much harder to reject sick children outright, and they’d have to keep paying out for a long time.
How terribly your insurance company responded to this challenge depended on what state it was operating in.
The first response by the insurance companies was to stop issuing child-only plans altogether. Companies across the nation started requiring at least one parent to be on the plan with the child, which (a) at least spread out the risk somewhat and (b) effectively priced a lot of parents and children out of the market.
States that like to regulate businesses for the good of the public put a stop to that. California, for example, said “Ha ha, that’s adorable. Issue child-only plans or you don’t get to sell insurance in this state at all.” Lo and behold, insurance companies in California mustered up some child-only plans real quick. Parents that lived in anti-regulation states weren’t so lucky.
There were several months in the state of Georgia, for example, during which it was impossible to buy a child-only plan. Think about that. Think about being a parent who’s already scraping to get by and finding out that you can’t protect your kid on this most basic level. This is why “government regulations are always bad” is not the handy rule of thumb people think it is.
Even the less terrible responses were still terrible.
Companies that operated in states where they were required to issue child-only plans panicked. The fear was that all those sick kids would jump onto their plans and tank the company. Even not-for-profit insurance companies panicked. I know this because I worked at one, and I heard a hell of a lot about people overloading sinking lifeboats. Health insurance companies across the country did everything they could to make themselves unappealing to parents with sick kids.
Fun Health Insurance Company Child Coverage Story Time!
During the Obamacare implementation, I worked on a brochure that explained our new child-only health plans. I came up with the best headline of my marketing life: “You tuck them in. We’ll keep them covered.”
The draft came back with the headline struck out and a handwritten note from a VP: “We will cover them if we HAVE to.”
But please don’t think that making the brochures unappealing was the only way insurance companies tried to fend off sick kids.
Bonus Fun Health Insurance Company Child Coverage Story Time!
As Obamacare kicked in and insurance companies could no longer use pre-existing conditions to hide from sick children, I was called into a meeting with a VP and two of the project managers I worked with. We needed to write and send out some letters, and fast. Because to keep all the sick kids from jumping onto our plans, we were hiking rates for child-only plans by 300–400%.
The project managers and I looked at each other for a silent moment and then burst into hysterical laughter. Mostly because it was the only way to keep from crying. Evil doesn’t always storm up with a cape and lightsaber. Sometimes it sidles in during a budget meeting.
I don’t know if those project managers and I were already frantically looking for new jobs before that meeting, but we definitely were after.
It’s Not the Subsidies
I bring that last story up because people assume that any Obamacare rate hikes – and we will get to those – happened because good, hardworking people all had perfectly good health plans and then poor people wrecked it all by jumping in and getting subsidized plans. It just isn’t true. Rates went up because insurance companies panicked over actually having to cover sick people.
Or, if you prefer, insurance companies, in being required to insure sick people, had to assume too much risk.
If we can agree that not letting kids linger and die is a general goal as a nation, it almost looks like we need some sort of national single-payer health plan.
And if you don’t want insurance companies to be able to knock kids off their plans or price them out of coverage, the time to call your elected representatives is now.
If you think your rep wouldn’t take coverage away from sick kids, think again. The House GOP met in the middle of the night January 11–12 for a mass-voting session. Among many other acts, Republicans blocked an amendment that would have allowed children to keep their coverage under Medicaid or CHIP. They also, for the record, voted to reinstate pre-existing conditions and stop allowing children to stay on their parents’ plans through age 26.
An interesting side point: Even not-for-profit insurance companies operate a lot like for-profit insurance companies. Being an insurance executive pretty much only qualifies you to be an insurance executive somewhere else, which means that (like many industries), insurance companies tend to trade executives back and forth. So even a non-profit outfit tends to swim right along with the sharks.
You might also wonder, while you’re thinking about that, why the executives at your health insurance company get paid at the rate they do. When Obamacare kicked in, I saw and heard about plenty of layoffs among low-level employees and contractors. What you didn’t hear about were executive pay freezes, because those things didn’t happen.
Hey. If You Knew All of This Was Going Down, Why Didn’t You Alert the Media?
I tried to. I risked my job to do so. Multiple media outlets told me the story was too hard to cover and research. Even when I offered to send them marked-up rate charts so they could see what was happening, even when I gave handy tips like “Have someone try to get a child-only health plan in Georgia.”
The media overall are not very good at reporting on Obamacare.
As you may recall, most of the media, particularly TV news shows, were only interested the football aspect of the fight: Two teams, and the GOP definitely thought Obamacare was bad and the Democratic Party definitely thought it was good. This resulted in infuriating incidents like networks running polls about whether people liked Obamacare or not and counting all “no” answers as not wanting the plan at all because Socialism!!!! instead of wondering if people were saying “no” because they didn’t think Obamacare went far enough.
Treating the insurance companies as anything other than passive was apparently too complex, even though they definitely were not passive about it. And that’s still happening. This summer, many news organizations reported on Aetna’s decision to leave ACA exchanges in several states as an inherent problem with Obamacare where, gosh darn it, an honest business just can’t make a living with this gummint health plan. In fact, Aetna might have been trying for a wee bit of leverage for its giant merger with Humana. Did that come up on many of your news feeds? Didn’t think so.
To cover this story or industry well, you need to have a depth of understanding that most news outlets just don’t have and don’t seem to be bothering to get. (This, by the way, is why financial companies loathe Elizabeth Warren. She has a full grasp on what they’re up to and is good at explaining it. They’re used to everyone outside the industry being a little baffled, including reporters.) With this latest round of stories on the ACA, I’m once again seeing plenty of reporting on the politics, but not much on how the industry works or how the major players are behaving.
The assumption that health insurance companies will bring back pre-existing conditions and lifetime caps the second they’re available is almost certainly correct. The assumption that your premiums will go down if the ACA goes away is laughable. But those are assumptions that a lot of media outlets are making. And those assumptions don’t serve your best interests.
Yes, There Have Been Premium Hikes. Sort Of.
Again, politicians and the media have been spreading the notion that it’s the only the new ACA enrollees who are driving up premiums. Insurance companies are quietly going along with that. It’s not entirely true.
It is true that insurance companies don’t like the new enrollees. It’s more risk than the insurance companies have ever had to deal with, and they much prefer the old system where the house always wins and they know by how much. So, yes, insurance companies have done some jacking up of rates to deal with the new potentially sick people. But subsidies are rising to cover the premium rises. Almost no one has acknowledged that. And way too many consumers haven’t gone on the exchange to find coverage they can afford.
Are You on the Exchange? Why the Hell Not?
If you’re upset about a rise in your health insurance costs, are you on a subsidized plan? Have you even gone to the national or state website to find out if you can get a subsidized plan? Because the vast majority of people who have screamed at me in real life and on the Internet about their premiums going up have not even freaking bothered to go on the freaking exchange and see what they can get.
Feel the shame.
You know how I’ve said above that there is no shame in not knowing about the ACA because politicians have deliberately been feeding you bad information? If your rates went up and you’re angry and you have not gone on the exchange because ew, Obama, you deserve every bit of that shame. There is no excuse for willful ignorance and self-harm. Yes, it might take you – at the outside – an hour to find an affordable plan that you like. A whole hour to save hundreds of dollars. How can you bear the burden?
OK, there is one instance in which you might not have to feel shame for not going on the exchange:
Your insurance company may have misled you about your pre-ACA plan.
I am taking the leap of suggesting that your insurance company may have misled you about grandfathered pre-ACA plan because mine certainly nudged people in that direction. I know that because I was one of the people who composed the letters.
We never actually said “your pre-Obamacare plan is better,” which in most cases would have been an outright lie, but we certainly tried to give people a sense of urgency about keeping their old, non-ACA plans. And then we used that urgency to jack up their rates.
Remember, if you’re on one of those grandfathered pre-Obamacare plans, you can still:
- Be charged more just because you’re a woman.
- Hit yearly caps for care.
- Hit lifetime caps for care.
- Miss out on key coverage that Obamacare requires.
And your rates almost certainly went up. Really worth hanging on to, right? Hey, let’s look at that last key coverage point up there!
Your friend’s old plan was cheaper because it secretly sucked.
I’m sure your old coverage did not suck. You are a savvy consumer. Also, people tend to put up mental walls to avoid the knowledge that they may have been taken advantage of, so we will not be discussing your old coverage. We will be discussing your friend’s cheap pre-Obamacare coverage. Which probably sucked.
There did indeed used to be cheap, unsubsidized health insurance plans out there. Insurance companies used to be able to offer these plans by – stay with me – not covering a whole bunch of stuff. Stuff that turns out to be crucial should you need it. Obamacare requires insurance plans to cover that crucial stuff.
Your friend who used to crow about how he had a $45-a-month plan and it worked just fine was lucky enough to never have used his plan. Ask him if he ever did more than go in for a yearly physical – or if he even did that. Because if your friend with the cheap pre-Obamacare plan needed, say, mental health coverage, he would have discovered that he would have been just as well off paying $45 a month for the use of a lucky penny.
Oh, your friend doesn’t need mental health coverage because he’s not the kind of guy who does? Amazingly enough, most people don’t think they’re going to need mental health coverage. (Just like most women don’t think they’re going to get raped and need abortion coverage, which Republicans would also like women to pay extra in advance for.)
Fun Cheap Health Insurance Story Time!
I had a relative who had one of those cheap pre-Obamacare plans. It was even a group plan, which are as a rule less horrible than individual plans. He’d always been happy and healthy and he didn’t have much money, so he went with his lowest-tier option, because coverage is coverage, right? And it was, until things went very wrong with some prescribed steroids he was taking for follow-up care. They made him manic. And then when that wore off, he felt like he could never be happy again. And he wasn’t covered for working with other drugs to solve that. We, his family, found out his plan didn’t have mental health coverage shortly after he tried to kill himself. The options were state psych ward – which the nurses who took care of him after the hospital stitched up his wrists begged him not to do – or nothing.
While his friends and family were scrambling to find him a therapist who would work on a sliding scale, he tried to kill himself again and succeeded.
Oh, hey. Turns out that’s not so much a fun story as a sad and enraging story.
And it’s one that happens less now because with the ACA, insurance companies can’t sell plans with huge, crucial coverage gaps.
Remember: Republicans are trying to repeal that. You too could have a plan that will surprise you with what it doesn’t cover.
Are the ACA Subsidies Raising Your Taxes?
The public has tacitly been given the impression that anyone who has a non-subsidized plan is paying for subsidized plans. Yes and no. Yes, the government does pay for subsidized plans. That does NOT affect your premium rates. It’s the government paying, not your insurer. There is a lot of confusion about that.
So, yes, theoretically health care subsidies are raising your taxes because the government needs money for them. But that’s only if you ignore how the effect of the ACA is lowering your taxes. You probably shouldn’t do that.
Some of the worst coverage that I personally saw – though I know there was far worse out there to see – was by Joe Scarborough of MSNBC’s Morning Joe. Scarborough’s way of handling the ACA debate was to announce with mock-bewilderment that no one had yet explained to him how Obamacare was supposed to be saving tax dollars. And then he would demand that his guest do so in under two minutes. And then, just in case, he would repeatedly interrupt that guest.
Scarborough would conclude the segment by saying that he still just didn’t see how this could be saving him money, releasing a great cloud of smugness, and throwing to commercial, presumably to give the guest time to smash some crockery in frustration.
For you, Joe, I will break this down real easy.
- Emergency room care is some of the most expensive care on the planet. For example, org estimates that treating an earache at an emergency room costs $400, compared to $110 at an urgent care center.
- People who cannot afford medical care do not go to urgent care centers. They go to emergency rooms, where they can’t be turned away because of an inability to pay.
- We pay for that.
- People who cannot afford medical care don’t go to emergency rooms when they think something might be wrong. That would involve taking time off work or missing crucial hours of sleep after that double shift.
- People who cannot afford medical care go to emergency rooms when something is already very wrong.
- Treating something that is starting to go wrong is way less expensive than treating something that has gone wrong. A Pap test, for example, costs $50 (or less) to perform. Treating cervical cancer can easily run from $30,000–$45,000.
- Obamacare gives 30 million people access to preventive care – such as cancer screenings – that they didn’t have before.
Are you beginning to see the math on this, Joe?
One more thing while we’re thinking about Obamacare and the economy…
Nobody goes bankrupt in a vacuum.
Neo-Libertarians would have you believe that the weak go bankrupt, too bad for them, and everyone else keeps rolling. The fact that one can go bankrupt because of cancer without any financial missteps is shrugged off.
But the rest of us do not, in fact, just keep rolling. Someone who goes bust is not paying bills, not buying goods, and not paying for services. Someone who loses their home affects the entire housing market in your area. Someone who goes under has to rely on government services. Someone who goes under has to go to the emergency room for medical care. Which they don’t do until something goes very wrong. It is still very easy to go medically bankrupt even if you have good health insurance. It’s even easier if you have a high-deductible plan or the kind of health savings account that focuses on shifting costs to the consumer. Guess which kinds of health insurance plans are becoming more common?
It’s almost like we should have some sort of national single-payer health plan.
What Will Happen if Obamacare Is Repealed?
- Pre-existing conditions will come back with a vengeance.
- Lifetime care caps will come back.
- Women will have a harder time getting basic reproductive care.
- Lower-income women will have a harder time getting prenatal care.
- Women will be charged more for coverage than men.
- Your premiums will not go down. Charges at that level are the new normal.
- But your subsidies will go away.
- And you will have exciting new access to plans with huge gaps in coverage.
- Millions of people will be priced out of insurance.
- People who rely on the ACA for current lifesaving treatments will be cut off.
Yes, Trump just announced that he wants health care for all. Has he given any specifics? Are you comfortable with Trump and your elected representatives – most of whom have never had to worry about affording health care in their lives – winging this without your input?
What Can I Do?
Be polite, but make it clear that if they screw up your health care, you will not forget it when 2018 rolls around. Make it clear that you vote. Let your reps know that you need more than “something else,” you need a specific plan with a careful rollout.
If you like Obamacare, let them know. If you want a single-payer plan, let them know. Even if there are parts of the ACA that you don’t like, make sure your reps are aware of which pieces you don’t want to lose. Most important, if you are currently receiving medical treatments that you stand to lose, tell them.
Without your firm input, any new plan will be written by insurance industry lobbyists. You’ve seen how well they take care of you when they’re left to their own devices.
Call your representatives.
Good health to us all.