The ACA: No Coverage for Biting Off Your Nose to Spite Your Face

The Affordable Care Act is helping a lot of people – by last count 3 million people newly enrolled in coverage through the health insurance marketplaces, 6.3 million more signed up for or renewed their Medicaid or CHIP coverage and 3.1 million young adults were allowed to stay on a parent’s plan until they turn 26. And it will help millions of people access critical preventive care and treatment for chronic diseases, injuries, and other health problems.

But unfortunately it’s not a cure for poor financial decisions, as witnessed recently in Congressman Louie Gohmert’s decision to go without health insurance.

As reported by the Dallas Morning News, the Congressman, a Republican from Tyler, Texas, has decided to forgo any health coverage at all for himself and his wife, even though his employer – the federal government – kicks in approximately 70% of the cost of his premium.

Representative Gohmert, 60, is reportedly upset because his premium is rising. Previously, Representative Gohmert’s premium costs were pooled with younger, healthier congressional staffers, so the true cost of his health care was hidden from him. Now, however, Members of Congress and their staff must purchase their health plan through the new marketplaces so his premium more closely reflects his actual health risk. But even though he’s more exposed to his age-related health care costs, this staunch opponent of the ACA is likely getting a far better deal than any coverage he could have purchased on his own, before the ACA. His plan is now only allowed to charge him up to three times the amount of a younger staff member because of his age; before the ACA he might have faced as much as a nine-fold difference in price if he bought a plan on his own.

Representative Gohmert has stated publicly that he would prefer to go without any coverage at all than pay a higher premium. He is apparently banking on never getting sick or having an accident – at a time when the charge for just one inpatient stay at a hospital in Dallas can range from $14,000 to $158,000, depending on the diagnosis. Most independent financial advisers would likely tell him to keep his coverage, especially when his employer is paying most of the bill.

Representative Gohmert is taking a big risk and putting his family’s financial security in jeopardy to make his point. The good news? If he and his wife can just stay healthy, they only have a few more years before they are eligible for Medicare (assuming they are willing to accept that kind of government insurance plan).

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