‘Death spiral’ claim is fake news; let’s fix ACA, not kill it
An inconvenient fact is elbowing its way into the national discussion about Obamacare.
The Affordable Care Act, to use the formal name, is not “failing,” not “exploding,” not in a “death spiral.”
It’s not, that is, unless President Donald Trump and Republicans in Congress push it over a ledge. Which Trump has threatened to do.
The latest evidence for the unheralded health of the ACA comes from a source close to home: Florida Blue, the largest health insurer in the Sunshine State. The nation’s Blue Cross companies are the backbone of many ACA markets.
As The Post’s Charles Elmore reported Monday, Florida Blue’s “medical loss ratio” has improved steadily over the past three years, according to Standard and Poor’s. It’s a measure of what insurers pay for medical services compared to the income they get from customers’ premiums.
In 2016, Florida Blue’s ratio was 75.2 — for every $100 it received from insurance premiums, the company spent $75.20 to pay health care providers. Or, as Florida Blue said, its after-tax profitability was in the “high single digits.” It was a big improvement over 2014, when the ratio was 94.3, a much tighter profit margin.
And S&P found that other Blue Cross companies, such as in Michigan, New York and North Carolina, chalked up profits in 2016 almost as robust as Florida Blue’s.
Their conclusion: The “ACA individual market is not in a death spiral,” S&P said — a direct rebuke to Trump and to the unending critics who’ve been saying for years that Obamacare was going to destroy the economy, bankrupt the Treasury and crush small businesses.
None of this has happened. Still, no matter how wrong their predictions, no matter how disappointingly beneficial the ACA insists on being, the critics believe they have a political obligation to keep their many promises to kill it.
As we’ve said before, Obamacare has its problems in many markets: Premiums are spiking. Out-ofpocket expenses are rising. The regulations are tough on some small-business employers.
But some 20 million people have gained insurance through Obamacare, driving down the nation’s uninsured rate to a record low 8.6 percent. Still more people would be insured if states like Florida hadn’t stubbornly rejected the chance to expand Medicaid.
And after all their groaning, the Republicans’ suggested fixes have been a joke. Only 17 percent of Americans supported the bill that crashed and burned in Congress in March. No wonder. That quickly hatched plan would have caused 24 million Americans to lose their health coverage by 2024 and to sharply hike up the premiums of older, poorer people.
Still, the Trump White House keeps pushing for “repeal and replace,” if not this week then next, or the week after — although no one specifies what a new plan would look like. What we’ve heard so far sounds no better than before.
One idea would let states decide whether to keep the ACA’s assurance that you get health coverage without regard to pre-existing conditions, and you get benefits like preventive and maternity care. A hefty 70 percent of Americans reject that idea, according to a Washington Post/ABC News poll released this week.
Were that state-optional plan to be enacted, roughly 7.8 million non-elderly Floridians would be in danger of being denied insurance because of pre-existing conditions, according to ACAsignups. net, which tracks health care numbers. That includes 1.14 million people in the four congressional districts for Palm Beach County.
Trump and congressional Republicans do hold the power to cripple Obamacare — by refusing to fund the subsidies that help poor people buy premiums on the marketplace. Trump has threatened to use this power as blackmail to bring Democrats to the bargaining table.
We won’t know until the end of the week whether Trump will compound the cynicism by dangling that funding as part of budget deal to avert a government shutdown.
What we do know is that a majority of Americans — 61 percent according to the WashPost/ABC poll — want Congress not to replace and repeal Obamacare, but to keep Obamacare and improve it.