Stamping out Oughtism, a HUGE hole in Obamacare

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Stamping out Oughtism, a HUGE hole in Obamacare

by Steve and Tim­o­thy Imholt (mainly Steve, Tim was too angry, as he is an adult with autism and has an autis­tic son he pays out of pocket to cover.)

Do you remem­ber the debate about why Oba­macare was going to be so very good or so very evil (depend­ing on who was hog­ging the micro­phone)? Regard­less of where you fell on the scale from pro­gres­sive to arch con­ser­v­a­tive, one area which had very lit­tle argu­ment was over what health­care should cover regard­ing chil­dren. Yes, there was argu­ment about the role of gov­ern­ment, about gov­ern­ment over reach, about fis­cal con­se­quences, but about kids?

Nope, I don’t remem­ber it.

I bet you don’t either.

I can remem­ber the dis­cus­sions about orphan drugs. I remem­ber com­ments from both sides about cat­a­strophic cov­er­age. Even dis­cus­sions about pre-​existing con­di­tions. These were things that most peo­ple thought the ACA would/​should (depend­ing on party affil­i­a­tion) cover. Even the insur­ance com­pa­nies and the Repub­li­cans in a last ditch effort to stop the ACA talked about other leg­is­la­tion, in place of the ACA, that would cover pre-​existing and cat­a­strophic situations.

But what they didn’t do was talk about sit­u­a­tions that were fix­able when the fix was expen­sive. Talk about donut holes. There is donut hole in cov­er­age the size of the Hol­land Tun­nel if you work for most com­pa­nies. You see, the way things are today, some kinds of ill­nesses actu­ally ARE cov­ered by the ACA mar­ket­place and pub­lic aid, but NOT through employer plans pre­cisely because they are so expen­sive, and the employ­ers had good lob­by­ists to get word­ing in there for an exemp­tion for employer based plans.

Still oth­ers aren’t cov­ered by the ACA mar­ket place OR the employer because get this… they are too expen­sive. It’s like find­ing a Ho Chi Minh tun­nel at the bot­tom of a Florida sized sink­hole. You take the tun­nel because you have to.

Is there a poster child for this hole? Autism.

You see, when you catch autism early it is treat­able. But the treat­ment needs to be aggres­sive. And even bet­ter, its effects can be truly man­aged and even called cured. But the cur­rent costs are some­where higher than $30,000 and in some cases even $50,000 per year for sev­eral years. Most employ­ers would rather not have to deal with that kind of cost. And (please use a Gomer Pyle voice when read­ing this), Sur­prise, Sur­prise, Surpirse, state and fed­eral laws say they don’t have to cover it.

Think about this. The employed per­son has to pay out of pocket to get his kids treated. That same per­son has to pay taxes that, in turn, pay for sub­si­dized cov­er­age for other peo­ple, some of whom don’t have a job, so that their kids can get this treat­ment because the ACA says that they can. So one guy gets to fork out the money twice, or if he can’t afford for his kids to get these treat­ments out of his own pocket has real problems.

That is assum­ing the guy who has a job can find a way to afford it. How many peo­ple have that kind of money left­over from the rest of their bud­get in their after tax salary? Espe­cially with all the new tax rates, hikes in gro­cery store prices, and stag­nant wages in the mid­dle class.

It is a nutty sit­u­a­tion, but that is just one prime exam­ple. We are SURE there are oth­ers. We will be on the look­out. Just fol­low bank­ruptcy fil­ings and some will likely be found.

The ACA act itself pro­vides a par­tial loop­hole as well. Turns out the Fed doesn’t always cover it because it’s a con­gen­i­tal con­di­tion. Those plans which do cover it are a lot more expen­sive. Cur­rently, the only real option left for a fam­ily with an aver­age income is for the kid to get put on pub­lic aid. On pub­lic aid, the kid can get cov­ered. Except that like a Ho Chi Minh tun­nel, the hole can col­lapse at any moment.

Now for those read­ers who don’t have to deal with this every day, get­ting on pub­lic aid is NOT like switch­ing cable com­pa­nies. You need to get qual­i­fied again, and again, and again. It takes a lot of effort by par­ents to pull it off. And each time they have to requal­ify, treat­ment gets impacted either because docs won’t accept it, or they can’t actu­ally deliver until approved (again and again and again).

Remem­ber that com­ment about catch­ing it early, and being aggres­sive? Let’s be blunt. Being aggres­sive is not com­pat­i­ble with gov­ern­ment paperwork.

So, as a coun­try, we end up actu­ally caus­ing kids to not get the treat­ment they need, exactly when it would do the most good. All because com­pa­nies didn’t want to have this really large cost, and the Feds on ACA didn’t want the pre­mi­ums to go up even more than they are going up next year.

How did it get this way? From my per­spec­tive, it was because from the pro­gres­sive stand­point, it had to be cov­ered, so stick­ing it to the states was a good idea. (Actu­ally for some of the pro­gres­sives, any­thing that even­tu­ally will lead to a sin­gle payer sys­tem is a good thing, no mat­ter how many kids get tram­pled in the mean­time). But the con­ser­v­a­tives aren’t off the hook either. Again, from my stand­point, allow­ing com­pa­nies to exclude this kind of thing, is the direct equiv­a­lent of being Pon­tius Pilate, wash­ing their hands. Why? Because for con­ser­v­a­tives, any­thing that shows how bad the ACA is must be good, no mat­ter how many kids are trampled.

From my per­spec­tive, polit­i­cal autism has erad­i­cated pub­lic oughtism.

The sad­dest part of all? It’s not those kids know­ing that they won’t be treated today. You see, none of them will notice it today because they are too young, and they really do have issues. And it prob­a­bly won’t be those kids when they are grown, because at the speed they won’t get treat­ment, they will have chal­lenges, at a much higher rate than they should. And the annual cost of that will be paid by every­one, just as the inef­fec­tual treat­ment they will get because of a defec­tive pub­lic aid system.

Yet keep send­ing these yahoos back to Wash­ing­ton, again, and again. Per­haps it’s the pub­lic who is more autis­tic than we would ever want to admit.

by Steve and Timothy Imholt (mainly Steve, Tim was too angry, as he is an adult with autism and has an autistic son he pays out of pocket to cover.)

Do you remember the debate about why Obamacare was going to be so very good or so very evil (depending on who was hogging the microphone)? Regardless of where you fell on the scale from progressive to arch conservative, one area which had very little argument was over what healthcare should cover regarding children. Yes, there was argument about the role of government, about government over reach, about fiscal consequences, but about kids?

Nope, I don’t remember it.

I bet you don’t either.

I can remember the discussions about orphan drugs. I remember comments from both sides about catastrophic coverage. Even discussions about pre-existing conditions. These were things that most people thought the ACA would/should (depending on party affiliation) cover. Even the insurance companies and the Republicans in a last ditch effort to stop the ACA talked about other legislation, in place of the ACA, that would cover pre-existing and catastrophic situations.

But what they didn’t do was talk about situations that were fixable when the fix was expensive. Talk about donut holes. There is donut hole in coverage the size of the Holland Tunnel if you work for most companies. You see, the way things are today, some kinds of illnesses actually ARE covered by the ACA marketplace and public aid, but NOT through employer plans precisely because they are so expensive, and the employers had good lobbyists to get wording in there for an exemption for employer based plans.

Still others aren’t covered by the ACA market place OR the employer because get this… they are too expensive. It’s like finding a Ho Chi Minh tunnel at the bottom of a Florida sized sinkhole. You take the tunnel because you have to.

Is there a poster child for this hole? Autism.

You see, when you catch autism early it is treatable. But the treatment needs to be aggressive. And even better, its effects can be truly managed and even called cured. But the current costs are somewhere higher than $30,000 and in some cases even $50,000 per year for several years. Most employers would rather not have to deal with that kind of cost. And (please use a Gomer Pyle voice when reading this), Surprise, Surprise, Surpirse, state and federal laws say they don’t have to cover it.

Think about this. The employed person has to pay out of pocket to get his kids treated. That same person has to pay taxes that, in turn, pay for subsidized coverage for other people, some of whom don’t have a job, so that their kids can get this treatment because the ACA says that they can. So one guy gets to fork out the money twice, or if he can’t afford for his kids to get these treatments out of his own pocket has real problems.

That is assuming the guy who has a job can find a way to afford it. How many people have that kind of money leftover from the rest of their budget in their after tax salary? Especially with all the new tax rates, hikes in grocery store prices, and stagnant wages in the middle class.

It is a nutty situation, but that is just one prime example. We are SURE there are others. We will be on the lookout. Just follow bankruptcy filings and some will likely be found.

The ACA act itself provides a partial loophole as well. Turns out the Fed doesn’t always cover it because it’s a congenital condition. Those plans which do cover it are a lot more expensive. Currently, the only real option left for a family with an average income is for the kid to get put on public aid. On public aid, the kid can get covered. Except that like a Ho Chi Minh tunnel, the hole can collapse at any moment.

Now for those readers who don’t have to deal with this every day, getting on public aid is NOT like switching cable companies. You need to get qualified again, and again, and again. It takes a lot of effort by parents to pull it off. And each time they have to requalify, treatment gets impacted either because docs won’t accept it, or they can’t actually deliver until approved (again and again and again).

Remember that comment about catching it early, and being aggressive? Let’s be blunt. Being aggressive is not compatible with government paperwork.

So, as a country, we end up actually causing kids to not get the treatment they need, exactly when it would do the most good. All because companies didn’t want to have this really large cost, and the Feds on ACA didn’t want the premiums to go up even more than they are going up next year.

How did it get this way? From my perspective, it was because from the progressive standpoint, it had to be covered, so sticking it to the states was a good idea. (Actually for some of the progressives, anything that eventually will lead to a single payer system is a good thing, no matter how many kids get trampled in the meantime). But the conservatives aren’t off the hook either. Again, from my standpoint, allowing companies to exclude this kind of thing, is the direct equivalent of being Pontius Pilate, washing their hands. Why? Because for conservatives, anything that shows how bad the ACA is must be good, no matter how many kids are trampled.

From my perspective, political autism has eradicated public oughtism.

The saddest part of all? It’s not those kids knowing that they won’t be treated today. You see, none of them will notice it today because they are too young, and they really do have issues. And it probably won’t be those kids when they are grown, because at the speed they won’t get treatment, they will have challenges, at a much higher rate than they should. And the annual cost of that will be paid by everyone, just as the ineffectual treatment they will get because of a defective public aid system.

Yet keep sending these yahoos back to Washington, again, and again. Perhaps it’s the public who is more autistic than we would ever want to admit.