The Obamacare Boiler Room

Just four miles north of Mar-a-Lago, two men in their mid-forties are currently on trial for conspiracy to defraud Obamacare of $161 million via a family insurance brokerage called the Fiorella Insurance Agency. Their alleged scheme was a variation on a rich Florida tradition that dates back at least to the late 1960s: use fancy luncheons and freebies to induce poor and desperate people to sign up for government-subsidized insurance plans, count on poverty and desperation to keep them from complaining too loudly when and if their claims get denied, buy yacht(s).

Since the first experiments in Medicare and Medicaid privatization in the early 1970s, entrepreneurs from Miami to Naples to Port Saint Richey have used everything from supermarket gift cards to opioids to lure the poor and unsuspecting onto the rolls of unscrupulous health maintenance or “accountable care” organizations and their affiliated insurance companies. The Fiorella agency’s innovation was that it specialized in selling Obamacare, the individual insurance plans designed for self-employed professionals, very small businesses, and others who’d had trouble obtaining health insurance before the new shopping “marketplaces.”

As the Affordable Care Act’s legacy has been tarnished by the protracted orgy of corporate consolidation and financialization that followed its passage—to say nothing of surging costs and plunging life expectancies—the fact that hemophiliacs and parents of children with muscular dystrophy maintain the right to buy health insurance instead of living in constant fear of bankrupting their employers or getting kicked off the rolls remains a relatively unalloyed achievement of an otherwise terrible law/presidency. Or at least, I thought it did.