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National Public Radio, in its “Perspectives” segment hosts a listener who offers a commentary about a social condition that bothers them or an idea they have to make the world a better place. So, the other day I heard a story from a 60-year-old who had been laid off from his job in a technology field after fifteen years with a major Bay Area company. He was in good company, because he was one of 6,000 employees asked to leave. It was now a hurdle for him to get a job, because companies saw the advantages of hiring younger employees who were “tuned in” to the Silicon Valley culture but mainly much cheaper.

The odds are that this person will wind up in a part-time or lower-paying job. But what would have been the health insurance situation for him and his family prior to the Affordable Care Act? Until recently, the demographic of middle-class hard working Americans between 45 and 65 was, in some ways, the disenfranchised, vulnerable sector of our society with the most to lose. What if this listener or his spouse had had a pre-existing health condition that would have made them uninsurable a few years ago? The Affordable Care Act, as long as it lasts, solves the problem today. It serves roughly 16 million people who otherwise would not have had coverage.

What struck me was the fact that today’s 16 million who benefit from the program may be an entirely different group from the 16 million covered five to ten years from now. In other words, there’s a revolving door of people who need the coverage during the time they are unemployed or working for a company that does not provide coverage --- or until they become eligible for Medi-care. In the meantime, at least some of those people or their spouses will manage to obtain a job that provides coverage for the family at some point, so over time eventually all of the 16 million becomes a different population served by the healthcare act.

It doesn't take much math to extrapolate and surmise that the 16 million “slots” may be filled by five times as many different people over the next ten to fifteen years. In that period alone, over 80 million Americans may enjoy the peace of mind that exists in other industrialized nations that offer universal coverage. To talk about unintended consequences, think about what this will mean for the now half-empty bankruptcy courts where, before Affordable Care, over fifty percent of all personal bankruptcies were the result of uninsured health care costs. Those who had something to lose lost everything.

Thankfully, the cost of providing this critical safety net is turning out to cost the government 20% less than originally anticipated according to the non-partisan Congressional Budget Office. As for small employers like me, the cost of conventional health insurance at my company would have risen next year because the new policies have to include more coverage for things like maternity and newborn care, drugs, lab services, children’s dentistry etc. Kaiser’s rates, however, did not go up because their regular coverage has always included almost all of the so-called ten “essential health benefits” that Affordable Care mandates. Since the rest of the industry had treated them as “add-ons” the resulting premium increases are the result of more care rather than increased cost of existing care.

It will be interesting to see if the Supreme Court ends Affordable Care with the stroke of a pen. Who knows? They may succeed where over forty attempts by Congress have failed. Some options for people left in the void (including young people not yet fortunate enough to become part of the tech feeding trough) may include the following:

  1. Move to one of the 16 states with their own health exchanges;
  2. Use a dating app to find a spouse that’s still covered;
  3. Run for elected office where, in most cases, you get health insurance for the rest of your life after just one term in office;
  4. Struggle to obtain a municipal or government job where you typically get lifetime health insurance for you and your family after say, five years on the job (San Francisco) or one day of work in places like the now-bankrupt Stockton.

A post- Affordable- Care world, if it comes, will demand some creativity to remove the specter of bankruptcy for anyone who experiences the perfect storm of job loss and a pre-existing condition.