Coverage does not equal access — this political quip used to argue against the ACA is indeed true. Not sure why the answer is not that *no* coverage pretty well ensures no access.

It was a little silly to say that no one would need to change plans or doctors with the new law. Each new annual enrollment period at work, we have different plans and, yeah, I have to change plans even though I liked the one five years ago that had WAY lower deductables, lower out of pocket expenses, and lower cost to purchase. It isn’t available. I remember my mom changing doctors a number of times in the 80’s because her doctor no longer accepted whatever insurance she had at the time. Why one would claim the ACA would change facts that have been true as long as insurance has been about is beyond me. But the claim was made, so it’s a point of criticism for the law.

I guess the implication is that the AHCA will provide both coverage and access. I’ve read the bill … and not heard anyone explain how the changes even provide coverage let alone access. I guess if fewer people can afford coverage, the lucky ones who can don’t compete for appointments anymore. But that’s hardly a selling point for a bill — a bit like saying we’ve increased selection at the grocery store by making sure 18% of your neighbors can no longer afford food.

There’s a balance in the ACA that I don’t really like. But I *understand* that if we are going with the insurance model of health care and don’t want insurance companies to refuse to cover pre-existing conditions, we’ve got to ensure they’ve got customers who aren’t sick. In this light, the proposed changes to the AHCA allowing states make up their own list of essential services makes a bad bill even worse. I’d be able to have “continuing” coverage (and thus not be someone who could be charged a surcharge from an insurance company) by buying the cheapest policy available that covers only sprained left wrists. Then when I *actually* get sick, buy a good insurance policy that covers actual medical care.