The Oba­macare at­tack

Our view: As open en­roll­ment be­gins, Trump en­gages in mis­lead­ing rhetoric re­gard­ing the Af­ford­able Care Act that cyn­i­cally ig­nores its suc­cesses

Baltimore Sun - - FROM PAGE ONE -

In an elec­tion sea­son rife with mis­in­for­ma­tion and out­right false­hoods, is there any is­sue where vot­ers are so thor­oughly led astray as Oba­macare? To hear Don­ald Trump de­scribe the Af­ford­able Care Act and the push to cover more Amer­i­cans through pri­vate health in­sur­ance, it’s a “failed health care takeover” and his vow to re­peal it is “one of the sin­gle most im­por­tant rea­sons” he will emerge vic­to­ri­ous on Nov. 8.

Long ago, Repub­li­can strate­gists cir­cled this week on their cal­en­dars. It’s not only the fi­nal days be­fore the elec­tion, but Nov. 1 also marked the be­gin­ning of the an­nual sign-up pe­riod for ACA health plans, and this year, a lot of cus­tomers — those who buy in the in­di­vid­ual mar­ket — are fac­ing sub­stan­tial premium in­creases. Cir­cum­stances vary, but some peo­ple are see­ing rate in­creases of 100 per­cent or more, and that’s quite an “owie,” as pe­di­a­tri­cians like to say.

But here’s where that head­line mis­leads. First, a rel­a­tively small per­cent­age of Amer­i­cans buy their health in­sur­ance through the in­di­vid­ual mar­ket. The vast ma­jor­ity get it through their em­ploy­ers or other groups or through gov­ern­ment pro­grams like Medi­care or Med­i­caid. And the ma­jor­ity of peo­ple who do pur­chase in­di­vid­ual poli­cies through the Oba­macare mar­ket­places qual­ify for a sub­sidy, so any ad­di­tional amount they must pay out of pocket may be quite small.

As a re­sult, of­fi­cials es­ti­mate that about 70 per­cent of Oba­macare ex­change cus­tomers can get min­i­mum cov­er­age for about $75 a month in out-of-pocket costs. Granted, these are low-cost plans with lim­ited ben­e­fits, but they do meet min­i­mum stan­dards for med­i­cal cov­er­age. Even those in­di­vid­u­als who are fac­ing sharper in­creases can blunt the im­pact if they shop around or re­duce their level of cov­er­age.

That’s not to dis­miss the gen­uine hard­ship some peo­ple face in pay­ing for health in­sur­ance, some of whom are hit hard­est not by pro­vi­sions of the ACA but by their states’ re­fusal to broaden Med­i­caid cov­er­age. In­deed, the high­est premium in­creases across the coun­try were felt in states that opted out of the Med­i­caid ex­pan­sion. And such a choice by states comes with a much higher bill than in­creased pre­mi­ums — peo­ple with­out health in­sur­ance cov­er­age are more likely to face se­ri­ous ill­ness or pre­ma­ture death than peo­ple who have it and use it.

Mr. Trump, who has been call­ing for a spe­cial ses­sion of Congress to “re­peal and re­place” Oba­macare (with­out hav­ing a work­able re­place­ment) con­ve­niently ig­nores the ACA’s big­gest suc­cess — 20 mil­lion more Amer­i­cans with health in­sur­ance cov­er­age. To­day, less than 10 per­cent lack health in­sur­ance while over­all fed­eral spend­ing on health care is down — about $2.6 tril­lion less over a five-year pe­riod than what was pro­jected be­fore Oba­macare be­come law.

And that’s not all. Be­cause of the ACA, Amer­i­cans can’t be Open en­roll­ment on Oba­macare in­sur­ance ex­changes opened this week, prompt­ing a round of mis­lead­ing at­tacks on the pro­gram from Don­ald Trump. re­fused cov­er­age for pre-ex­ist­ing con­di­tions, chil­dren are al­lowed to be cov­ered by their par­ents’ health in­sur­ance un­til age 26, there are no life­time caps on in­sur­ance claims, and pre­mi­ums out­side the Oba­macare mar­kets have sta­bi­lized at 4 per­cent an­nual growth. Odd, how those im­prove­ments don’t tend to make it into Repub­li­can stump speeches.

Part of Oba­macare’s prob­lem is that younger, health­ier in­di­vid­u­als aren’t sign­ing up for cov­er­age; they’d rather risk the penalty. And so that leaves sicker cus­tomers in the pool, and as they make claims, in­sur­ance providers are forced to raise pre­mi­ums to re­coup their costs. As any in­sur­ance com­pany will tell you, when the risk pool shrinks, bad things tend to hap­pen.

There are any num­ber of ways to fix these prob­lems, but Repub­li­cans in Congress aren’t will­ing to make the changes. They’ve put all their po­lit­i­cal eggs in the bas­ket of re­peal. Even the most fleshed-out GOP coun­ter­pro­posal to date, the one of­fered by House Speaker Paul Ryan dur­ing the sum­mer, is mad­den­ingly vague on the de­tails of what hap­pens to Oba­macare pol­i­cy­hold­ers who now ben­e­fit from gov­ern­ment sub­si­dies.

No mat­ter who wins next Tues­day, it’s dif­fi­cult to be­lieve that the ACA is go­ing to be re­pealed. That’s sim­ply not the na­ture of fed­eral en­ti­tle­ment pro­grams (Oba­macare ef­fec­tively be­ing about half-en­ti­tle­ment). The far more re­al­is­tic out­come is to pur­sue fixes that Repub­li­cans will find po­lit­i­cally ac­cept­able — in­creas­ing penal­ties for those who fail to sign up, per­haps, or ex­tend­ing sub­si­dies to the most cat­a­strophic med­i­cal cases. Fail­ures in the Oba­macare in­sur­ance mar­ket can be fixed if there’s enough po­lit­i­cal will to do it.


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