There is nothing that will keep insurance companies from just deciding the entire state is a high risk pool and charging more.
And the past two years, after watching insurance companies actually claim they had to leave state pools because the cost was just too high for the shareholders, I don't think they'll be very generous and deign to maintain affordable premiums for the state pools.
Medicaid may be expanded, but without the federal supplemental that the taxes paid for, there will be a huge gap between those who qualify for the Medicaid expansion, and those with pre-existing conditions who can afford what the state - and employers - will be able to provide as part of a high-risk pool.
So we go back to pre-ACA. Where people took on useless catastrophic insurance and hoped their auto and home insurance policies would be enough to stitch both together pay for any accidents or injuries, and prayed they didn't get cancer, or have a mental health issue, or any fatal diseases or conditions - or even just need glasses or dental work, because they as a family just couldn't afford medicine or therapies to mitigate or cure those.
Here's a few comments:
Prior to the ACA, most of my employers did not include dental or vision. At that time, even making a reasonably above poverty line salary, I avoided the dentist, and paid $200 - $500 every other year for the cheapest optical check-up and lenses (re-using old frames) just for myself because it was too damn expensive but never was enough to be able to itemize as a medical deduction on the 1040, instead of just pretty much ignoring as a non-taxable/pre-tax exempted benefit, as my other health benefits and worker's comp/EEO exemptions were.
Now with dependents that have genetically bad teeth, I certainly don't want to go back to those days. Any gains to my income over the years will be wiped out just to pay full freight for my family's health care.
And if I lose my job, they're facing the same potential loss of productive lifespan that my grandparent's generation did - where people who worked physical labor or high-stress mid-level management jobs were far more likely to die before they hit 65 just due to the stress and toll on their bodies.
What is needed is single payer, Medicare for all or Tricare for all that will at least cover a standard of health care and keep emergency or critical treatment costs affordable. And if health care is "run like a business" that requires profits for investors and market participation, that can never happen.
This is not the same as "running a break-even tab" with a local doctor or even a hospital. Once a profit margin is imposed onto a service, that profit margin, that "interest return" is locked into the cost of health care just as a loan shark locks in his/her vig into that "friendly emergency business loan" they push on you after your shop windows were mysteriously broken over the weekend.
Haele
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