My oldest was a micro-preemie—born more than three months early.
The NICU nurses called them “million-dollar babies,” these tiny humans hooked up to machines, clinging to life and to their mom’s little finger. My son actually hit his lifetime cap on health insurance before he ever left the hospital.
That used to be a thing. You could just…run out of health coverage. And what are you supposed to do if your child uses up their insurance simply by being born?
That’s one of the reasons the Affordable Care Act (Obamacare) mattered so much. It banned lifetime and annual caps. It also banned insurance companies from denying you or charging you more because of a pre-existing condition—things like diabetes, cancer, even pregnancy. Yes, pregnancy used to count as a pre-existing condition.
The ACA also helped more people afford insurance through subsidies. During Covid, those subsidies were expanded so more families could actually keep coverage. Now those expanded subsidies are set to expire, and Republicans in Congress don’t want to renew them because they require government spending. At the same time, they talk about cutting Medicare and Medicaid.
Here’s why that matters for everybody, not just people who are sick.
Insurance works because lots of people—healthy and sick—pay into the same pot. Most people don’t need big payouts most of the time, so their premiums help cover the people who do.
But if subsidies go away and premiums jump, the first people to drop coverage are usually the younger and healthier ones—the folks who think, “I’ll risk it.” The people who stay in the pool are the ones who really need care and can’t go without it.
That makes the whole pool sicker and more expensive.
When that happens, premiums and copays go up again, which pushes even more healthy people out. It’s a feedback loop.
And it doesn’t stop there.
People without insurance skip the basics—flu shots, checkups, mammograms, colonoscopies. Preventive care is how we catch problems when they’re small and cheap. If fewer people are getting that care, doctors’ offices and hospitals have less steady income, so some of them cut staff or close—especially in rural areas where margins are already thin.
Meanwhile, more uninsured people end up in the ER with problems that could have been handled in an office visit months earlier. Emergency care is the most expensive kind of care. And hospitals that take Medicare have to stabilize anyone who walks in, whether they can pay or not, and no matter their immigration status. (We want that. We do not want people dying in parking lots.)
But when more people show up unable to pay, and at the same time public programs like Medicaid and Medicare are cut, hospitals get squeezed hard. Rural hospitals are usually the first to go. When they close, people lose both jobs and access to care.
So one policy change—letting ACA subsidies expire—doesn’t just mean “some people pay a bit more.” It ripples:
1. Premiums go up.
2. Healthier people drop coverage.
3. The insurance pool gets sicker and more expensive.
4. More people skip preventive care.
5. ERs get crowded with harder, costlier cases.
6. Hospitals and clinics, especially in rural areas, struggle or close.
7. People lose jobs and care at the same time.
The ACA isn’t perfect, but it was built to stop exactly this spiral. Letting those supports lapse takes us backward—to a world where a baby can hit their lifetime cap before they even come home.
Most rich countries – and many ‘well-off’ countries – have some form of universal health care that works. The US doesn’t, but at least with Medicare, Medicaid, and ACA subsidies we can help vulnerable people and support the entire health care system.
The overarching theme that I see in the political realm right now is this divide between people who are angry that some folks get free stuff from the government (like food and health care) and they don’t want to pay for that. But everyone who works pays taxes into that system. And the reality is that these subsidies really do benefit everyone in a indirect way.
Medicaid and Medicare help fund hospitals and doctor’s offices, making care more accessible for you. SNAP benefits for some spread out in the local economy, helping to pay cashiers at your local grocery store and supporting the farmer down the street.
And in case you needed a reminder, undocumented immigrants don’t get Medicaid, Medicare, free health care, or SNAP. They don’t qualify. They DO however get lifesaving care at hospital ERs under emergency circumstances, and yes, we want that for them. No one deserves to die alone in the street.
Maybe you like less government interference, maybe you like more. But I think we can all agree on the need for a country with more compassion for those suffering around us.
Climbing down off my soapbox to get my kids off to school.