Session 235

Jen Briney is host of the Congressional Dish podcast and joins me today to talk about our current healthcare system and where it may be headed.

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Today's guest is very interesting as it's someone who wouldn't normally be here on the podcast but with the changing landscape of our U.S. healthcare system, I thought of bringing an expert in this field. Jen Briney's Congressional Dish podcast is devoted to talking about bills that go through Congress. She has read the Affordable Care Act (ACA), Current TBAC, the new AHCA, and has discussed what's in there or not. She comes on the podcast today to talk about these things so you can come prepared for your medical school interviews. This is going to be a good primer for our healthcare system even if you listen to this in 2018 or 2019, assuming there are no dramatic changes.

[03:15] The Congressional Dish Podcast

Being a Congress-watcher, Jen watches Congressional hearing and reads bills and laws being created so that taxpayers, like her, would know what's going with their money. What led her to become so familiar with healthcare was the government shutdown in 2013 when the Republicans were trying to repeal the Affordable Care Act (ACA). She did not like the system as a whole because it's an insurance system, not a healthcare system. But Jen believes it's better than we had before because rules have been put in on the insurance industry. Currently, the Republicans have control of all of government. They're trying to repeal the Affordable Care Act but instead of repealing it, they're putting together bills very quickly with no hearings and no overall plan.

What Jen does now is she's reading all the different versions. She has read the first one that failed. But now the house just passed another version of the American Health Care Act, which she's reading for her next episode.

[05:22] An Insurance Policy, Not a Healthcare Policy

Jen explains there are different ways you can give people healthcare. A lot of other countries do "single payer" where you pay taxes and the government pays for healthcare. It's one of those essential government functions.

Conversely, the United States buys health insurance which is supposed to cover the big catastrophes. Before the ACA, these are for profit companies so what they would do is only cover healthy people because it would cost them the least. What health insurance does is you give them $100 a month and as long as you're healthy, they just put that in their pockets. That's profit. But as soon as you get sick, that's when they have to start to pay for stuff and they really don't like this part.

In order to have this system that still had private insurance at the center of it, the Affordable Care Act put rules in place. Before the ACA, there would be lifetime limits. You'd sign up for a plan. You get cancer and then you look in the fine print of your insurance and they would say, "Once we hit $1 million, we're not paying for anything for you ever again." And you would go bankrupt.

Another common practice with health insurance where once someone would get sick, they would just drop their plan. They would no longer cover you because they don't have to. Basically, they were doing all kinds of shady things to make money.

Why Jen thinks the ACA is better is because there are certain rules. For instance, there are now 10 essential health benefits that if you buy health insurance, they have to cover it such as preventive care. Jen shares her experience that when she went to get a physical exam and all the little bills came in, it cost her over $400. Now, that's illegal. Thanks to the Affordable Care Act. They also have to cover things like ambulances, hospital stays, maternity, prescription drugs, etc. There are things now that when you buy insurance, you know you're going to get. It's better than it was was before but it's still based on private insurance.

What you see now is these insurance companies liked the old days where they could profit by making up all the rules. Now the people in Congress working on behalf of the insurance industry are trying to make those rules go away. These are the people writing legislation designed to help the insurance industry to be more profitable. They're eliminating these rules so these essential health benefits are going to be flexible in certain states, if states wanted to, so they won't have to cover those essential health benefits anymore. This is not something that's good for the people, but it's good for the businesses.

[08:50] Congress Working for Businesses, Not for the People

Jen mentions the website OpenSecrets.org where you can look and see these people who are voting for this elimination of rules and you can see where they're getting their campaign funding from and in almost every case, you can see the health insurance industry and health professionals. Then you can see these companies get invited to help write these bills to repeal the Affordable Care Act. In fact, these insurance companies were in the room to write the Affordable Care Act, as well as the pharmaceutical companies.  These health insurance companies want to exist so they use their lobbying power to stay in existence and that is the basis of the Affordable Care Act. Jen says a lot of people call it the "poison pill" and no one right now in Congress is talking about the "single payer" system, the tax-funded system that works in so many other countries.

Jen explains why she says these people are working for businesses and not for us is because when you look at what they're doing, that's who benefits. Jen always looks at who benefits financially. With the American Health Care Act of 2017 (AHCA), it's the businesses that benefit from it.

[10:21] The Affordable Care Act (Obamacare)

In Episode 48 of the Congressional Dish podcast, Jen read the Obamacare and shares some big takeaways.

First, it puts rules on the private insurance industry. It allows the private insurance industry to remain the main way that people get their healthcare in the United States. As opposed to now, if you wanted to get a government plan, you have to get Medicaid, a program for poor people that gives them their health insurance. The federal government picks up all of the Medicaid funding for the states that accepted it. It basically expanded the program beyond what it used to be. So it allows poor people to get government-funded health insurance. Medicare, on the other hand, is for people over the age of 65 and for the most part, they also get government-sponsored healthcare. Everybody else is in the middle. If you make more than 133% of the poverty line or under the age of 65, you have to get health insurance in order to get healthcare for the most part.

This is the basis of the Affordable Care Act. It's a very complicated system that tries to put rules in the private insurance companies so that they will not go bankrupt but still have to cover people with pre-existing conditions. This is expensive because these as your healthcare provider, these insurance companies would have to pay for those benefits for your entire life and they don't want to do that. Hence, ACA forces them to cover you and it forces healthy people to get health insurance to outweigh those costs. Jen thinks it's a very delicate system with a lot of moving parts that have to work together in order to make this private insurance system work.

However, this is currently being actively dismantled. Jen admits she doesn't know what to study when it comes to ACA because we really don't know how much of this is going to survive.

[13:15] Different Ways to Get Health Insurance

One way to get health insurance today is the individual market which didn't exist before. For instance, Jen as a podcaster doesn't have a big corporation paying for her health insurance so if she were single and needed health insurance, she would have to go to each individual company and try to figure out what they cover which can be very confusing. Jen basically ended up with a $400 physical since she had no idea what she was buying.

One of the basics of the ACA is that it has created this individual insurance market where people could go on a website and pick a plan from a selection of companies offering it and compare them based on the premium, coverage, percentages - all of which are being explained, which didn't exist before.

Through the ACA, it separated your healthcare from your employer so you could quit your job and still have health insurance. Apparently, there are so many people in this country that are clinging onto jobs they don't like because of their health insurance.

Other ways of getting health insurance include the small group market and the large employers, where most people in the country are still getting their insurance from. Moreover, the ACA also requires that employers buy plans that cover those ten essential benefits and have minimum of what needs to be provided in return for premiums.

Jen ultimately stresses that the Affordable Care Act keeps the private insurance company at the center of our healthcare and try to make it so they can be profitable and yet we get coverage with fewer...