Politicians debating health insurance traipse all over the concept of choice, often locating it in commerce. For consumers, it means a lot more.

Issue of Choice Dogs Obamacare Opponents

Horror stories abound about the tens of thousands of deaths per year, along with the general privation, pain and despair, that are predicted to ensue if the Affordable Care Act is repealed.

For many, the choices involved in purchasing health insurance are about much more than money. Visual: iStock.com/alexskopje

Here’s a quick, true story that is low in drama — no catastrophic illnesses or bankruptcies — but illustrative.

After moving to Northampton, Massachusetts from New York City in 2013, Alla Katsnelson, a freelance science writer, and her husband Geoff McKonly, a self-employed furniture maker, had to find health insurance for themselves and their two-year-old son. They decided on a plan offered by a state public authority that served as an insurance broker under Massachusetts’ health care reform law, an ACA precursor.

The next year, the ACA’s primary components went into effect, so the couple purchased a comparable plan for themselves through the newly established state exchange, and their son was enrolled in the expanded state Medicaid program.

The result was good quality health care and a 50 percent drop in the family’s annual health insurance costs, a savings which was a “huge deal” financially, Katsnelson says.

The couple could perhaps make more money if they worked for concerns owned by someone else, but freelancing suits their skill sets and allows for the quality of life they seek. They like having that choice.

This idea of choice shows up a lot in the rhetoric deployed by Obamacare opponents. Repeal advocates argue that removing the ACA’s mandate for coverage will afford consumers more choices about their health insurance coverage.

Joseph Antos, a scholar of health policy economics with the American Enterprise Institute, expanded on that the point during a webinar Tuesday, hosted by the USC Annenberg Center for Health Journalism.

Republican members of Congress have put forward “probably too many” plans in the past six or seven years to repeal and replace Obamacare, he said. And the various plans all lack detail and include provisions to alter some major aspects of the ACA that “are not going to go anywhere,” he added.

But “the idea of giving people choices is obviously in there,” Antos said. “The idea of subsidizing people buying insurance on their own will be there,” meaning that consumers could buy insurance directly from a private company rather than through a government-run program.

Ironically, Republicans have left themselves no political choice, Jonathan Gruber, a health economist at the Massachusetts Institute of Technology who helped design the ACA, said during the webinar.

Here is why: The insurance business works by redistributing premiums paid by low-risk individuals who tend not to get sick and thus cost insurers little, he said. Those funds then can be used to cover the significant expenses incurred by high-risk individuals.

Gruber contends that Republicans have painted themselves in a corner by opposing the known mechanisms that can be used to relieve the burden on private insurers — mandates to purchase insurance, expanded Medicaid, tax credits to draw lower-cost people into the pool, and payments to insurers to offset their costs. Other mechanisms will require spending more money.

“There is no replacement that is realistic,” Gruber said.

He likened The Affordable Care Act to a moving car being pursued by dogs.

“[Republicans] have been chasing this car and barking after it for six years now,” he said, “and now they’ve caught the car. And suddenly they’ve realized it’s kind of hard to do something.” Like drive it.

So what happens to Katsnelson’s choices for her family if Obamacare is repealed? Massachusetts could revisit the parts of“Romneycare” that it has replaced, but her family’s premium likely would rise significantly compared with its current premium under the ACA.

“I find it stupid, I find it ridiculous, outrageous,” she says, referring to the larger portion of her family’s income that might have to go to health insurance, “but of course it could happen and I think that we would have to suck it up” — which would limit many of her family’s choices.