Republicans in the US Senate are going ahead with “debate” [July 25, 2017] on repealing [and possibly replacing] the Affordable Care Act—a decision that could take health insurance away from 23 million people. Do they think of those 23 million as actual people in real towns—as their mothers, their fathers, their sisters and brothers,  their children, their grandchildren, their aunts and uncles? Or are they just abstract numbers in a political game? Do they realize—or even care about—the impact of what they are hoping to do?

How do we make this real for these folks? Maybe if we put it in political terms—votes—they’ll understand. So, let’s look at 23 million [or as many as 32 million, according to the Congressional Budget Office, depending on what model is being analyzed].

23 million is the rough equivalent of taking away health insurance from everyone who lives in New York City, Los Angeles, Chicago, Houston, Philadelphia, Phoenix, San Antonio, San Diego, Dallas, San Jose, San Francisco and Austin. That is absolutely apocalyptic.

Oh, wait. Republicans don’t care about people in big cities, because they don’t vote Republican. So, after contemplating the chilling reality of those numbers, disregard them.

Instead, let’s look at the equivalent of 23 million using smaller cities and towns, mostly in “red states,” where Republicans might give a shit, because that’s where the base is.

In this scenario, 23 million is the rough equivalent of taking health insurance away from everyone who lives in the following 100 cities, plus the entire population of Oregon.  [Population figures are rounded to the nearest thousand. And I’ve not included the “coastal” states that Republican leadership loathes. If you feel compelled to check my math, go right ahead. It’s within range. After 100 cities, I decided to stop charting and just add the Oregon shortcut: All you have to do is include Oregon’s 3.9 million people to make it add up to about 23 million. That should make Republicans happy.]

When you picture it this way, it is even more scary. Just a thought experiment to make you feel even worse about what is about to happen in Washington.

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Until we have single-payer, Medicare for All healthcare in America, insurance companies will continue to screw their customers in as many ways as possible. For now, though, the Affordable Care Act, aka Obamacare, is at least helping people who were previously uninsured–or uninsurable according to the skewed rules of the industry–to avoid health-crisis-induced bankruptcy. Many of the new rules in the Affordable Care Act eliminate the worst abuses of the old system. But bad practices persist. Recently, HealthCare-Now!–a group that advocates for  a Medicare-for-All system- asked its supporters to submit nominations for the 2013 Award for Profiteering and Deceit in the Private Health Insurance Industry. Of course, HealthCare Now’s contest was unscientific, and mostly a public-relations stunt, but the results are enlightening anyway. Based on the submissions HealthCare Now received, the top vote-getters  are:

UnitedHealth, for paying its CEO, Stephen Hemsley, $49 million in 2012. HealthCare Now notes that among CEOs, healthcare CEOs receive the highest median pay at $11.1 million. There are thousands of insurance companies, but the seven largest publicly traded health plans alone are paid their CEOs a collective $87 million.

Humana, for charging women over 50% more than men for the same insurance plan.

Anthem Blue Cross for predatory premium increases.

Moda Health for paying $40 million for naming rights to the Portland Trailblazers arena.

Each of these examples is emblematic of the stuff health-insurance companies continue to get away with, and that could be reigned in–if not eliminated–under a Medicare-for-All system. Or, as Health-Now puts it:

Under a single-payer health plan, health coverage would be offered as a public good to all, administered by civil servants who will not siphon millions of dollars meant for patient care into their personal bank accounts. So we could use that $87 million in wasted money on CEOs to pay for as many as 8,700 hip replacements.

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Want to know how affordable your health insurance might be under the Affordable Care Act, without actually having to sign up for a policy? You can do that. First, go to  healthcare.gov to window shop for plans available in your area–a step that does not require creating an account. I did it, and had zero problems finding the plans in my area. Then, you can easily see what kind of tax credit you might qualify for by consulting a handy dandy online calculator at  a site sponsored by the well-respected Kaiser Family Foundation.   You can even do some of the basic legwork for someone you know, because at this site, you don’t have to create an account or include any personal info—just annual income, state, county, and family size. It looks at your information and calculates how much of a tax credit you might quality for–based on a typical “silver” plan with good benefits.

Using just those two, easy steps, you can window shop without making a commitment. You can shop for yourself, or for your kids, or for your aunts and uncles. No hassle. No commitment. No waiting time. And very helpful. It doesn’t give you  your costs down to the penny–but at this stage, most people are just trying to get a feel for what their monthly or yearly costs might be.

So, if you’re not ready to sign on the dotted line, and you just want to get an idea of how the new Affordable Care Act will work for you, check out this site. Then, as the start-up kinks at healthcare.gov get unraveled—and they will, indeed, get unraveled, despite what Obamacare-haters want you to believe—you can read the fine print and officially sign up for the policy of your choice.

I did it, and I was pleasantly surprised at what I found.

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More evidence that President Obama’s healthcare reform program is beneficial:  Since the Affordable Care Act went into effect, young adults—who typically are the least insured because of either a sense of invincibility or a lack of funds [or both]—have been  joining the ranks of the insured, now that they can be covered, through age 26, by their  parents’ plans.

The Affordable Care Act allows children to remain on their parents’ health insurance plans until age 26.  This policy took effect for insurance plan renewals beginning on September 23, 2010, and was designed to address the fact that young adults are the age group least likely to have health insurance.  This is one of the important early provisions in the Affordable Care Act designed to expand insurance coverage to uninsured Americans.

New results released today by the National Center for Health Statistics show that the dependent coverage provision of the Affordable Care Act has had a significant impact on improving insurance coverage among young adults.

Data from the National Health Interview Survey (NHIS) show that in the first quarter of 2011, the percentage of adults between the ages of 19 and 25 with health insurance increased to 69.6%, from 66.1% in 2010.  This 3.5 percentage-point increase represents approximately one million additional young adults with insurance.  Data from Gallup and the Census Bureau released this month show similar findings.

Detractors of “Obamacare” will undoubtedly try to explain away these statistics, citing alternative causes for the upswing in young adults getting health coverage. But they’ll have a hard time making a solid case. The study’s authors looked at explanations beyond ACA and concluded:

While it is theoretically possible that the increase in insurance coverage for young adults in 2011 is due to some factor other than the Affordable Care Act, it is hard to identify a plausible alternative explanation for the increase in coverage among young adults. One possibility is that the recession did not affect young adults as much as other age groups, but in fact, the opposite occurred.  Unemployment among 20-24 year-olds increased by 7.3 percentage points (from 8.2% to 15.5%) from 2006 to 2010, compared to a 4.8 percentage-point increase among 25-54 year-olds (from 3.8% to 8.6%). Given the toll the recession has taken on employment among young adults, we would expect that insurance rates would, if anything, have decreased in this group compared to older adults.  This observation bolsters the conclusion that the increase in coverage among young adults is a result of the Affordable Care Act.

As for health insurance companies, they’d be smart to remain silent on this issue. Under the terms of ACA’s individual mandate, they’ve gained millions of new customers [meaning additional income from premiums], and can hardly complain about financial hardship.

It stands to reason [if it’s even possible to count on reason in the current, irrational political environment], that, as more consumer-friendly provisions of ACA take effect,  people will learn to love “Obamacare,” despite the negative propaganda from the right.

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In a step forward for self-employed people seeking health insurance, Washington state legislators have redefined the meaning of the word “group.” According to the Washington state insurance commissioner’s blog, starting on Oct. 1, 2010, people who operate one-person businesses will be considered a “group” for insurance purposes. This change means that sole-proprietors will be able to quality for group coverage.

It’s a big change from health-insurance business as usual, and one that is long overdue–not just in WA, but everywhere.  Under Washington state law in recent years, “small-group” coverage applied to businesses with 2 to 50 employees. Under the old rules, small groups could qualify for health coverage without health screenings. But one-person businesses were left out, meaning that they had to buy their insurance in the individual market, where health screening is the norm and coverage can be hard to find and expensive for people with pre-existing medical conditions.

Washington state’s new law puts it in a small group of its own: states that allow one-man groups. The 2-to-50-employee definition of a group is the norm in most states. If you’re self-employed with no other workers, only Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Maine and Mississippi—and now Washington give you the option of getting health insurance as a one-person group. Even in some of those states, you’re still excluded if you have pre-existing medical conditions, or if you’re not incorporated. And in some, “yes” really means “maybe,” because of some arcane regulations.

Of course, you can’t just go out and declare yourself to be a one-person business just to get into the new deal. Provisions in the new law requires people to show that:

They’ve been employed (or run) the same small employer for at least the last 12 months;
They’ve made at least 75 percent of their income (or 51 percent for agricultural businesses) from the business or trade.

Similar changes to federal law have been approved by Congress and signed by the president — they’re included in the federal health reform legislation passed this spring — but don’t take effect until 2014. So, kudos to Washington state and that handful of other for jumping in and not waiting.

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Community-owned-and-operated utilities are among America’s longest-running “public options.” So before writing off the healthcare public option completely and seeing it consigned to the junk bin of the messy health-reform debate of 2010, it might be illuminating to see what lessons we might learn from an historical precedent in a different service sector.

Let’s revisit the scorecard for publicly owned utilities. Consider that for more than 125 years a robust system of public, not-for-profit utilities has been reliably supplying water and electrical power to communities both large and small across America. Here are the astounding facts about this enduring, dependable, and highly successful “public option”:

• 45 million Americans receive their electrical power exclusively from public, community-owned and operated power companies
• 2.8 million businesses depend on public utilities for their electrical supply
• More than two thousand communities located in forty-nine states own and operate electric power providers, the largest of these being the Los Angeles Department of Water and Power (3.8 million customers) and the Long Island Power Authority (1.1 million customers)
• Rates paid by residential users of community-owned electrical supply are, on average, 13% lower than the rate paid by residential users of investor-owned utilities.
• Public utilities consistently have demonstrated better reliability, safety, and efficiency when compared with investor-owned utilities.

What accounts for the durability and success of the community-owned and operated utilities? First, there is their accountability to consumer/owners rather than to stockholders. Second, rates are set locally by citizen-controlled boards that operate with public oversight. Third, the utilities’ not-for-profit status and lower administrative costs result in lower rates. Fourth, they provide revenue to local governments. Finally, infrastructure improvements become valuable long-term assets of the communities themselves.

The fact is that these community-owned utilities act as a check on privately owned utilities and help to drive down overall rates. They also encourage privately held utilities to be more responsive to the needs of consumers, businesses, and communities. These positive benefits should sound a familiar note in the current debate about the role of the public option in healthcare.

If the lessons of 125 years of competition between investor-owned and public utilities in delivering tangible benefits and lowering costs can teach us anything, it is that greater competition for private health insurers in the form of a public option may reap similar benefits. The public option is not, as some would claim, a radical departure from the norms of competitiveness in the American marketplace. If, as seems likely at this time, the public option will not be part of the final health-reform bill, an opportunity to bring real competition, fairness, and affordability to health care will have been lost.

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