When I first set out on an entrepreneurial path I was ill-prepared for the evaporation of financial and health security that would come upon entering the individual insurance market. I wanted to sell books, but instead found myself sunk into the dystopian world of the individual insurance market before the Affordable Care Act, where consumers were forced to commit to a plan without any guarantee that our rates would hold or the coverage would meet our needs.
Back then, insurance companies could require “exclusions” in policies that eliminated coverage for certain health concerns. In my case, all treatments for back issues were excluded because of a back surgery I’d had five years earlier, one they labeled a pre-existing condition and a risk they didn’t want to take. Fortunately, I didn’t have any major back issues while I was on this threadbare plan. If I had, paying for the treatment I would have needed might have bankrupted us, forced us to close our business and lay off our employees.
When the ACA passed it was a godsend me and my family. I no longer had to worry that any twinge in my back might lead to financial ruin because I knew I could get the treatment I would have been denied under the old rules. Instead of yearly premium increases, our rates went were slashed. In the first year after the ACA came into effect, our premiums were cut in half, going from $2,000 to $1,000 per month. Under our new plan, coverage for the care we needed was expanded. We no longer had to forgo testing and other preventative care that was previously out of reach because of the high out-of-pocket expenses we paid with our old bare-bones plan.
The ACA meant savings for our household and a higher quality of life, but it also meant putting our family’s business on more solid footing. The quality insurance we now had under the ACA eliminated the risk that an unexpected medical situation would turn into a financial catastrophe and threaten our ability to keep our doors open. It’s removed a serious source of insecurity and allowed us to focus on growing our business.
And because the ACA has allowed our employees access to quality insurance we can’t afford to provide at our size, it’s helped us attract and retain the talented team that powers our business. In doing so it’s helped level the playing field for us as we strive to make sure that independent bookstores can thrive and support our neighbors in the era of online book giants that answer to shareholders not communities.
The full frontal attack on the ACA portends not only a disaster for public health, but a cynical undermining of small businesses, the people who run them and those that are employed by them. Across the country, thousands of shops like mine will close because some want insurance companies to be able to pick and choose who deserves coverage for what.
Judge Kavanaugh’s confirmation was not an intellectual endeavor, and it wasn’t a victory for conservatism. It’s very likely the onset of the dismantling of a basic pillar of society and our economy and the undermining of our basic right to health care. For millions of people like me with what insurance companies call pre-existing conditions, it’s a return to the dystopia of life without the protection of affordable, quality health care.