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.