Thanks, Oba­macare

Our view: The lat­est sta­tis­tics show Af­ford­able Care Act has been a suc­cess, but one in need of im­prove­ments — if only Congress would al­low it

Baltimore Sun - - FROM PAGE ONE -

One of the more amus­ing high­lights of Pres­i­dent Barack Obama’s cam­paign ap­pear­ance in Philadel­phia last week on be­half of Hil­lary Clin­ton was his use of the phrase, “Thanks, Obama,” to brag about his ac­com­plish­ments in of­fice — even adding $2-a-gal­lon gaso­line to the list af­ter some­one in the crowd hap­pily re­minded him. The irony, of course, was that his po­lit­i­cal op­po­nents have been us­ing the same phrase for years in a sar­cas­tic ef­fort to as­sign blame for most any­thing they per­ceived to be wrong about the coun­try.

Well, here’s an ad­den­dum: It’s past time Amer­i­cans started say­ing, “Thanks, Oba­macare,” to rec­og­nize the suc­cess of the Af­ford­able Care Act. And it’s not just the mil­lions of peo­ple who now have health in­sur­ance who couldn’t get it in the past — whether be­cause they couldn’t af­ford it or per­haps had a pre-ex­ist­ing con­di­tion that made it im­pos­si­ble to pur­chase — who should be grate­ful. It’s the mil­lions who have seen sig­nif­i­cantly lower in­creases in health in­sur­ance pre­mi­ums in re­cent years who should be happy that the much-ma­ligned law is on the books.

The ACA’s suc­cesses seem to get lost in the shuf­fle for two rea­sons. First, be­cause health care re­form has be­come so politi­cized, par­tic­u­larly in Wash­ing­ton where Repub­li­cans in Congress have voted to re­peal the law some­thing on the or­der of 60 times. Ter­ror­ists don’t suf­fer that many neg­a­tive votes on Capi­tol Hill. But sec­ond, be­cause an ob­vi­ous prob­lem has arisen that’s re­ceived a dis­pro­por­tion­ate share of at­ten­tion — the man­ner in which the in­di­vid­ual mar­ket is out of whack, with ris­ing pre­mi­ums and in­sur­ers drop­ping out of ex­changes.

That’s a le­git­i­mate con­cern, of course, but it’s one that needs to be put in per­spec­tive. The vast ma­jor­ity of Amer­i­cans get their health in­sur­ance through em­ployer-spon­sored group plans, not the in­di­vid­ual mar­ket, and those plans have re­mained rel­a­tively sta­ble in cov­er­age and rates. In Mary­land, as The Sun’s An­drea K. McDaniels re­cently re­ported, av­er­age pre­mi­ums grew by just 3.4 per­cent this year. Had the ACA not ex­isted, pre­mi­ums would be far more costly — about $1,300 per fam­ily more in 2015, by one es­ti­mate.

Why? Be­cause prior to the ACA, pre­mi­ums were grow­ing at a brisk10 per­cent an­nual clip. Since the law’s pas­sage, there’s been a down­ward pres­sure on prices — there’s more com­pe­ti­tion, more gov­ern­ment over­sight on rates, a cap on what in­sur­ers can charge for over­head as well as risk-abate­ment for in­sur­ers (so they can’t suf­fer cat­a­strophic losses). That doesn’t mean ris­ing health care costs are licked (out-of-pocket costs to con­sumers are a whole dif­fer­ent is­sue), but it cer­tainly means there’s been progress.

But let’s also not for­get that far more peo­ple are in­sured to­day than be­fore. In Mary­land, the per­cent­age of unin­sured has Pres­i­dent Barack Obama takes the stage in Philadel­phi­ato give a speech sup­port­ing Hil­lary Clin­ton’s cam­paign for pres­i­dent. dropped from11.3 per­cent of the pop­u­la­tion in 2010 to 6.6 per­cent in 2015. One re­sult is that peo­ple are get­ting health­ier (and are less likely to end up bankrupted by med­i­cal costs). Mean­while, the Cen­ters for Medi­care and Med­i­caid Ser­vices re­port that Mary­land’s Medi­care-re­lated hospi­tal read­mis­sions have dropped more than10 per­cent since 2010, another sign that health (and health care) is im­prov­ing.

Ob­vi­ously, the in­di­vid­ual mar­ket needs to be fixed. The state’s in­sur­ance reg­u­la­tors are al­ready look­ing at pre­mium in­creases of as much as 20 per­cent to 30 per­cent for next year in that seg­ment of the mar­ket where com­pe­ti­tion has been shrink­ing as car­ri­ers lose money. Over­all, the coun­try needs to find ways to make health care more af­ford­able for ev­ery­one. We spend far more and get far worse out­comes com­pared to other coun­tries, and the mid­dle class (who aren’t el­i­gi­ble for Med­i­caid) have taken the big­gest hit.

That doesn’t make Oba­macare the dis­as­ter its op­po­nents claim, it means the ACA was a start­ing point in res­cu­ing the pri­vate in­sur­ance mar­ket that was spi­ral­ing out of con­trol. If Congress could some­how get past the par­ti­san­ship, there are any num­ber of pos­si­ble fixes — make more mid­dle class work­ers el­i­gi­ble for ACA sub­si­dies, for in­stance, get more states to ex­pand Med­i­caid el­i­gi­bil­ity and cre­ate a “pub­lic op­tion” that pro­vides Medi­care­like cov­er­age for peo­ple who are younger than 65. Such re­forms could lead to bet­ter and more af­ford­able cov­er­age for mil­lions more Amer­i­cans while main­tain­ing health com­pe­ti­tion in the mar­ket­place and a cap on rate in­creases. That’s a win-win-win that even the most hard-hearted par­ti­san ought to em­brace.

MICHAEL BRYANT/TNS

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