I've said it before, but the Republican "healthcare plan" is for people to get sick and die, unless they are loaded with money. Pay to play, and if you can't pay, sucks to be you.
I’m not sure I dare to comment lest this become a rant. 😁. Thank you so much, Jonathan, for covering this stuff! (Gonna have to go follow Norm, too!). Healthcare in America saddens me!
The increase in denials is atrocious, as well. My insurance company literally set up a separate company and offers doctors to provide GLP1s, but after a little over a year, I can pay almost $500/ month and get it from Lilly or not at all. I have 4-5 issues that tirzepatide helps. My plan covers Mounjaro for T2D but not Zepbound (I meet the FDA guidelines here). I make good money, but with one income…
Figs - the scrubs maker - has been backing Dr Elizabeth Potter in speaking out and talking to Congress. (I’m guessing the lobby force is strong there, though).
It’s maddening and downright criminal.
This year, I had the opportunity to not just buy my HDP from Cigna, but also gap and/or catastrophic coverage as well. 🤦♀️
Our local medical conglomerates have started charging for 2 visits any time they can. I recently had my annual physical - practitioner adjusted my ADHD meds - yep, charged for 2 visits. Several hundred each to see my NP (who is the absolute best).
You are doing the Lord’s work covering this stuff and explaining it to people. It’s amazing how many folk don’t pay attention or try to understand it. This truly helps!
Applicants exaggerating their income so they can get financial help they desperately need is a perfect illustration of the absurdity of our current system. It's also a good example of this country's absolute contempt for poor people.
Meanwhile, lots of other folks are keeping a very close eye on their earnings so they don't go over the re-established ACA income cliff and get left holding the bag for thousands of dollars in subsidies, plus a tax penalty. So much for encouraging work! (Back in 2019, an employer accidentally submitted duplicate 1099s for me, which put me over the limit and led to an IRS bill for $18,000. It was fun getting that worked out.)
We don't have to live like this, and I don't understand why we tolerate it.
Health insurance and access to medical care will not be needed once the cuts to food assistance really kick in. Excess mortality due to malnutrition has probably been calculated and factored into the policy decisions taken by the T. Rump criminal enterprise. Problem is, hungry people tend to become angry people and once they realize the reason for their hunger they tend to revolt as a measure of self-preservation. Hence the need for massive increases in Homeland Security funding-to defend the homeland from the people attempting to make a living there. Regime change, anyone?
Trump recently saw at least a dozen doctors, while he sharply reduced or terminated health care to countless millions of Americans.
A proposed $1.5 trillion defense budget, a Trump ‘gut instinct’ costly folly in Iran, and a wrestling arena on the South Lawn while ordinary Americans are increasingly suffering medically and financially.
When will us ‘mice’’ rise up against the fat cats?
Thank you for the excellent reporting, Jonathon. Medicare for all would solve a multitude of problems. Getting rid of Medicare Advantage programs would help with the overall health care. I live in Ma and > 90% 0f the population has healthcare coverage, Ma makes it work.
Johnathan. Thanks for eloquently laying it all out
I grew up in apartheid South Africa, where the government was also very good at making the harm it caused disappear into bureaucratic language. People weren't dying because of policy. They were dying because of their own deficiencies, their own bad choices, their own failure to qualify. The machinery is different. The logic is identical.
In 2018 I had open-heart surgery in Toronto—aortic valve replacement, sternum split, the full version. My heart didn't restart properly, so I stayed an extra week and came out with a permanent pacemaker. The bill to me was $7.50 a day for bedside TV and phone. A friend in the US told me the same operation there would have run a million dollars.
That's not a healthcare system. That's a hostage situation.
Canada's model isn't perfect—the specialist queues are real. But in 48 years here, I have never once worried that illness would bankrupt me. Americans don't know what they're missing because they've never had it, and there are very well-funded interests making sure they never find out.
I've spent four years writing a novel about what happens when a society decides some people don't qualify. The Kingdom of America publishes July 4th, 2026. For an Advance Reader Copy: https://thekingdomofamerica.com/
The RWJ Foundation moto : "Toward a future where health is no longer a privilege, but a right." From a founder of Johnson and Johnson, one of the largest health care companies. And we as the richest country in history. Mistaken and misplaced priorities.
“Bazooka for an ant farm” is a funny analogy. I’ve also used “burning down the house because they dislike the living room couch.” I think these analogies miss the broader point. The right wing isn’t aiming to eliminate real fraud or waste. They’re aiming to remove the programs - full stop.
This is similar to the bullshit excuses given for election denialism, or redrawing maps within a day of SCOTUS’ VRA decision. It’s ultimately an ideological prerogative that only the “right people” deserve anything - healthcare, voting rights, etc.
The American right wing hasn’t been ‘conservative’ for a long time, it’s been reactionary and is currently fascistic. It doesn’t simply believe in maintaining a hierarchy and slowing the pace of change - it seeks to actively reserve it. Exhibit A is this.
P.s. When I hear fraud and insurance programs, I think of Sen Rick Scott and the great state of Florida.
Uninsured people cost everyone, particularly if you have health insurance, doesn't matter if it is through the ACA, an employer or private. Because people must be treated at emergency rooms whether or not they can pay, we all pay more. As is usual the GOP is pennywise and dollarfoolish, and the chief aim is to hurt as many people as possible
Apparently the little people commit fraud in great numbers. The mega corporations that obtain government contracts, sometimes on no bid contracts, do not.
"estimate in a recent Paragon report that there are more than 6 million improper or fraudulent enrollees" - prove it. Oz's boss is in charge of FBI & DOJ. Where are the indictments, let alone convictions? This admin can prowl through mortgage loan applications to gin up charges of "fraud" (albeit that dissolve upon objective inspection by courts). How weak is this president if his top appointees aren't proving cases of this supposed medical insurance fraud? What a sad, failed, flaccid law enforcement effort
As insurance costs continue to increase, and the number of uninsured or underinsured increases, Medicare for all looks increasingly appealing. Voters need to elect politicians who agree that healthcare is a right, not a privilege (hint: it’s not Republicans).
There are several issues raised in this article that are confusing to me as a former Arizona Medicaid employee and as the Director for the implementation of the Medicaid policies and systems that interface with the federal system. I retired in 2014 a year after the initial implementation and the full implementation of the new web based eligibility system.
One of the important things I think people need to know about the ACA, is that it isn't just about health insurance coverage in the federal marketplace. It is an enormous bill that oversees changes to many programs and impacts many federal laws. Certainly some things can have changed since I retired 12 years ago. But, not a lot of things. No one is willing to open up the ACA for making improvements at the risk of Republicans getting in and gutting it.
The ACA added health care protections for ALL Americans and not just those enrolled in ACA insurance plans. As a result of the law No health insurance plans can deny coverage for pre existing conditions, all insurance plans have to provide a minimum set of mandatory services, no insurance plans can automatically drop your children when they turn 18. If they are continuing in school they are covered to age 26. No insurance plan can charge women higher rates than men. No insurance plan can end your coverage for hitting annual or lifetime coverage limits. And many more items.
So I am not understanding the issues raised by the broker in Georgia. Again, I retired 12 years ago and only worked a year under the actual implementation of the ACA, but I don't understand how the broker has clients getting into insurance plans with maximum coverage limits and pre existing conditions. Can anyone answer that for me? I will go back and check some sources I have.
Thanks! I see there are some exceptions, which probably applies everywhere. But in looking through KFF articles all of the consumer protections I listed above would be in place for most insurance coverage.
The issue is that most of the alternative sources of coverage (like indemnity plans -- or the Christian sharing ministries that advertise heavily on satellite radio) are not subject to ACA rules
Good to know. And that sure is crappy. I am relieved to confirm that most health insurance plans and employer sponsored insurance coverage has to obey these consumer protections. I worked for the State of Arizona for 32 years because I had a pre existing condition and could not reliably get coverage with any private employer.
I've said it before, but the Republican "healthcare plan" is for people to get sick and die, unless they are loaded with money. Pay to play, and if you can't pay, sucks to be you.
Cutting benefits under the guise of combatting fraud is right out of Ronald Reagan's play book.
I’m not sure I dare to comment lest this become a rant. 😁. Thank you so much, Jonathan, for covering this stuff! (Gonna have to go follow Norm, too!). Healthcare in America saddens me!
The increase in denials is atrocious, as well. My insurance company literally set up a separate company and offers doctors to provide GLP1s, but after a little over a year, I can pay almost $500/ month and get it from Lilly or not at all. I have 4-5 issues that tirzepatide helps. My plan covers Mounjaro for T2D but not Zepbound (I meet the FDA guidelines here). I make good money, but with one income…
Figs - the scrubs maker - has been backing Dr Elizabeth Potter in speaking out and talking to Congress. (I’m guessing the lobby force is strong there, though).
It’s maddening and downright criminal.
This year, I had the opportunity to not just buy my HDP from Cigna, but also gap and/or catastrophic coverage as well. 🤦♀️
Our local medical conglomerates have started charging for 2 visits any time they can. I recently had my annual physical - practitioner adjusted my ADHD meds - yep, charged for 2 visits. Several hundred each to see my NP (who is the absolute best).
You are doing the Lord’s work covering this stuff and explaining it to people. It’s amazing how many folk don’t pay attention or try to understand it. This truly helps!
Applicants exaggerating their income so they can get financial help they desperately need is a perfect illustration of the absurdity of our current system. It's also a good example of this country's absolute contempt for poor people.
Meanwhile, lots of other folks are keeping a very close eye on their earnings so they don't go over the re-established ACA income cliff and get left holding the bag for thousands of dollars in subsidies, plus a tax penalty. So much for encouraging work! (Back in 2019, an employer accidentally submitted duplicate 1099s for me, which put me over the limit and led to an IRS bill for $18,000. It was fun getting that worked out.)
We don't have to live like this, and I don't understand why we tolerate it.
Health insurance and access to medical care will not be needed once the cuts to food assistance really kick in. Excess mortality due to malnutrition has probably been calculated and factored into the policy decisions taken by the T. Rump criminal enterprise. Problem is, hungry people tend to become angry people and once they realize the reason for their hunger they tend to revolt as a measure of self-preservation. Hence the need for massive increases in Homeland Security funding-to defend the homeland from the people attempting to make a living there. Regime change, anyone?
Trump recently saw at least a dozen doctors, while he sharply reduced or terminated health care to countless millions of Americans.
A proposed $1.5 trillion defense budget, a Trump ‘gut instinct’ costly folly in Iran, and a wrestling arena on the South Lawn while ordinary Americans are increasingly suffering medically and financially.
When will us ‘mice’’ rise up against the fat cats?
Not to mention approaching a quarter trillion in funding allocated to ICE/CBP. The priorities are clear.
The democrats really need to push for universal Healthcare.
Thank you for the excellent reporting, Jonathon. Medicare for all would solve a multitude of problems. Getting rid of Medicare Advantage programs would help with the overall health care. I live in Ma and > 90% 0f the population has healthcare coverage, Ma makes it work.
Johnathan. Thanks for eloquently laying it all out
I grew up in apartheid South Africa, where the government was also very good at making the harm it caused disappear into bureaucratic language. People weren't dying because of policy. They were dying because of their own deficiencies, their own bad choices, their own failure to qualify. The machinery is different. The logic is identical.
In 2018 I had open-heart surgery in Toronto—aortic valve replacement, sternum split, the full version. My heart didn't restart properly, so I stayed an extra week and came out with a permanent pacemaker. The bill to me was $7.50 a day for bedside TV and phone. A friend in the US told me the same operation there would have run a million dollars.
That's not a healthcare system. That's a hostage situation.
Canada's model isn't perfect—the specialist queues are real. But in 48 years here, I have never once worried that illness would bankrupt me. Americans don't know what they're missing because they've never had it, and there are very well-funded interests making sure they never find out.
I've spent four years writing a novel about what happens when a society decides some people don't qualify. The Kingdom of America publishes July 4th, 2026. For an Advance Reader Copy: https://thekingdomofamerica.com/
The RWJ Foundation moto : "Toward a future where health is no longer a privilege, but a right." From a founder of Johnson and Johnson, one of the largest health care companies. And we as the richest country in history. Mistaken and misplaced priorities.
“Bazooka for an ant farm” is a funny analogy. I’ve also used “burning down the house because they dislike the living room couch.” I think these analogies miss the broader point. The right wing isn’t aiming to eliminate real fraud or waste. They’re aiming to remove the programs - full stop.
This is similar to the bullshit excuses given for election denialism, or redrawing maps within a day of SCOTUS’ VRA decision. It’s ultimately an ideological prerogative that only the “right people” deserve anything - healthcare, voting rights, etc.
The American right wing hasn’t been ‘conservative’ for a long time, it’s been reactionary and is currently fascistic. It doesn’t simply believe in maintaining a hierarchy and slowing the pace of change - it seeks to actively reserve it. Exhibit A is this.
P.s. When I hear fraud and insurance programs, I think of Sen Rick Scott and the great state of Florida.
"burning down the house because they dislike the living room couch"
that's good!
Uninsured people cost everyone, particularly if you have health insurance, doesn't matter if it is through the ACA, an employer or private. Because people must be treated at emergency rooms whether or not they can pay, we all pay more. As is usual the GOP is pennywise and dollarfoolish, and the chief aim is to hurt as many people as possible
Apparently the little people commit fraud in great numbers. The mega corporations that obtain government contracts, sometimes on no bid contracts, do not.
"estimate in a recent Paragon report that there are more than 6 million improper or fraudulent enrollees" - prove it. Oz's boss is in charge of FBI & DOJ. Where are the indictments, let alone convictions? This admin can prowl through mortgage loan applications to gin up charges of "fraud" (albeit that dissolve upon objective inspection by courts). How weak is this president if his top appointees aren't proving cases of this supposed medical insurance fraud? What a sad, failed, flaccid law enforcement effort
As insurance costs continue to increase, and the number of uninsured or underinsured increases, Medicare for all looks increasingly appealing. Voters need to elect politicians who agree that healthcare is a right, not a privilege (hint: it’s not Republicans).
There are several issues raised in this article that are confusing to me as a former Arizona Medicaid employee and as the Director for the implementation of the Medicaid policies and systems that interface with the federal system. I retired in 2014 a year after the initial implementation and the full implementation of the new web based eligibility system.
One of the important things I think people need to know about the ACA, is that it isn't just about health insurance coverage in the federal marketplace. It is an enormous bill that oversees changes to many programs and impacts many federal laws. Certainly some things can have changed since I retired 12 years ago. But, not a lot of things. No one is willing to open up the ACA for making improvements at the risk of Republicans getting in and gutting it.
The ACA added health care protections for ALL Americans and not just those enrolled in ACA insurance plans. As a result of the law No health insurance plans can deny coverage for pre existing conditions, all insurance plans have to provide a minimum set of mandatory services, no insurance plans can automatically drop your children when they turn 18. If they are continuing in school they are covered to age 26. No insurance plan can charge women higher rates than men. No insurance plan can end your coverage for hitting annual or lifetime coverage limits. And many more items.
So I am not understanding the issues raised by the broker in Georgia. Again, I retired 12 years ago and only worked a year under the actual implementation of the ACA, but I don't understand how the broker has clients getting into insurance plans with maximum coverage limits and pre existing conditions. Can anyone answer that for me? I will go back and check some sources I have.
I did a quick search in Washington State, and while it might vary state to state, non-compliant plans are available. Here is a quick link to review.
https://www.insurance.wa.gov/insurance-resources/health-insurance/health-insurance-coverage/aca-vs-non-aca-health-coverage-options
Thanks! I see there are some exceptions, which probably applies everywhere. But in looking through KFF articles all of the consumer protections I listed above would be in place for most insurance coverage.
Thanks for reading and commenting!
The issue is that most of the alternative sources of coverage (like indemnity plans -- or the Christian sharing ministries that advertise heavily on satellite radio) are not subject to ACA rules
Good to know. And that sure is crappy. I am relieved to confirm that most health insurance plans and employer sponsored insurance coverage has to obey these consumer protections. I worked for the State of Arizona for 32 years because I had a pre existing condition and could not reliably get coverage with any private employer.