John Boehner discovers the market for individual health insurance and doesn’t like it

Rep. John Boehner is shocked, shocked, that his insurance premiums will rise, now that he he’s out of the government’s health plan and shopping the market for individual policies.

Well, guess what? The premiums you have to pay as an individual have always been higher than those group plans charge for similar coverage. That is, if you could get health insurance at all. Before the Affordable Care Act (Obamacare) took effect, insurance companies could turn you down if you or a family member had even minor health issues. They could drop your policy if you got sick. A 64-year-old heavy smoker like Boehner could easily have been rejected or charged far, far more than he’s paying now.

He seems to have had no idea. He never saw, understood, or cared about what families not in group plans faced before the ACA.

Boehner dropped his excellent government group plan and applied for individual coverage under the ACA because his political party demanded it. The GOP passed an amendment to the health-care bill requiring legislators and their staffs to switch to new ACA health exchanges. The Democrats accepted the idea.

In group health plans, everyone is treated alike. Older people pay the same premiums as younger people do. You cannot be turned down or charged extra because you or your family member is ill. Workers who are young or healthy subsidize their elders and workers with health problems. Men subsidize women’s pregnancies. Their employer subsidizes them all.

The ACA brings similar rules to the market for individual policies. Insurance companies now have to accept all comers, regardless of health. They can charge older people more than the young but not as much more as they did in the past. As with employer insurance, the young or healthy help subsidize the rest. Once the ACA’s tech problems are solved, most individuals (not all) will pay less for comparable coverage than insurers charged in the past.

So Boehner has actually entered a much-improved market for individual health insurance and still thinks it’s bad. That’s actually good news. For the first time, he and his Congressional colleagues might start paying attention to why health care costs so much. They’re not insulated any more.

If the law were repealed, as Boehner hopes, he’d go safely back to his gold-plated government health policy. And the rest of us? We’d become invisible again. So yes, John & Co., hang in there with the ACA. You now have an incentive to improve it.

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MyName // 11/26/2013 at 5:17 am

Thanks, Jane, for summing up what probably most Congressional people will see when they sign up for the ACA. Surprise, guys! Join the rest of us. And you think it is bad now?

Melanie Tayler // 11/26/2013 at 11:05 am

Good article. Thanks so much for all your insights and for posting them and educating the rest of us. Thank you.

Simon Zhang // 11/27/2013 at 4:48 pm

I don’t think the report from Politico has the whole story. John Boehner’s premium is $433 per month now, and would have to be $802 in DC’s exchange. However, the federal government is paying much more for his insurance, so the total premium is much higher. It’s only reasonable to compare his current premium with his future premium after government subsidy, which will cover 75%. So his actual premium will be around $200, which is lower than what he’s paying now (of course the deductible will be higher).

Richard Vinson // 03/30/2014 at 11:41 am

Well Jane, I would like to make you a bet. You say “Once the ACA’s tech problems are solved, most individuals (not all) will pay less for comparable coverage than insurers charged in the past.” I will bet you a $100.00 Starbucks card that most people will pay more. Would you like to take me up on that?

Jane // 04/07/2014 at 4:41 pm

I only bet on horses! So far, a the horror stories trumpeted in ads mostly turned out not to be true. Once the case was investigated, the ACA did provide lower premiums. Where it didn’t, people were paying, say, $50 a month for insurance that covered almost nothing. So far, average published state rates have been lower, but time will tell.

Norm Doty // 04/07/2014 at 2:14 pm

Comment on your March 2014 article in AARP Bulletin. You repeated the false statement that insurers can cancel or surcharge your existing policy if you get sick. Not true (I’m a 30 year insurance agent). My own Iowa Blue Cross individual policy specifically states that neither of those can happen. State regulation would back me up if they tried. I challenge anyone to produce any case of an existing policy being cancelled or up-rated solely due to new illness. I would bet a lot that there would be other factors.

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