Concepts of a Health Plan

This is not a political post, it is just a first-person account of how insurance in pooled plans actually affected my family’s life growing up.

In the 9/10/2024 presidential debate, Trump said he has “concepts of a plan” that is better than the Affordable Care Act. His running mate Vance has explained the plan, which is to separate people into different insurance pools according to their health conditions/risk levels.

I’m old enough to recall when this was the model for plans. My parents had a small business, and the health insurance plan they purchased was great; it covered my parents and 5 kids at a reasonable price. But it was that style of plan, where once you were in a group, you couldn’t switch to a new plan if you had any health issues, as they wouldn’t accept you. And, in the meantime, people that were healthy could drop out of the plan and find another one, but anyone that had a health condition that they developed while on the plan had no choice but to stay on that plan or have no insurance.

So when both my parents had issues (high blood pressure for my dad, and emphysema for my mom) they found that the pool of people in the plan now consisted of only people that were costing the insurance company money, so the rates got higher, higher, higher until they were more than our mortgage plus food each month, and they had to cancel.

Which meant, for us kids, we were not allowed to participate in sports. We couldn’t go on trips with school groups. We were told to not injure ourselves. My sister popped her shoulder out when we were climbing a tree, and since we didn’t want to get in trouble, I pulled it back into place. All of us discovered as adults that we had broken bones during the decade of no insurance, as we went into doctors (after getting jobs with insurance coverage) for injuries and were asked why we never got a broken wrist bone or a leg bone set (me), or my sister that had a broken collarbone and foot, or my other sister who had broken her tailbone, and has one leg an inch longer than the other from a hip injury. None of these mishaps were reported to my parents, of course. And broken bones as a child can cause problems later in life.

The business model that allows insurers to refuse to insure people with pre-existing conditions leads to this problem, and overturning it was a key driver of the ACA.

With an election coming up, I’m a bit concerned that people that have never had to experience pooled insurance won’t know how it impacts families that must buy insurance outside of a company-provided plan. If you are planning to start a business, or in risk of getting laid off from a job in the future, you’ll quickly find that there is no pooled insurance policy you can afford if you have any previous or chronic health issue. Whoever you vote for, make sure you make your concerns known if you care about the health insurance industry and it’s potential impact on your life.