SHOULD OBAMACARE SURVIVE?
Election-year premium spikes draw new attention to the health law’s future
Jill:
Bad news on premium hikes is giving conservatives an excuse to once again call for the electric chair for the 2010 law with two unfortunate names. It was political malpractice for the Obama administration to allow the name Obamacare to take hold. It was also ridiculous for Democrats in Congress to call their bill the Patient Protection and Affordable Care Act. No matter what it costs, health care is never going to be considered affordable.
What we have here is akin to a clash of civilizations: Liberals who believe health care is a right and a public good that shouldn’t hinge on private insurers trying to remain profitable, and conservatives who believe the free market and canny individual shoppers can drive down costs. From those starting points, the two sides have been trying to either make the law work or do what they can to make sure it doesn’t.
I bought health insurance twice under this law, so I know it better than most Americans. There are a few key points that should not get lost, including that 20 million people have gained insurance under ACA; that Republicans have not offered plans on a similar scale; and that we can fix much of what’s wrong if we all take a few steps toward the middle ground.
David:
Let’s dispense with this 20 million number first. The majority of those who gained health insurance coverage were added to Medicaid. That’s not health care “reform”; it is spending. The second largest group, as many as 6 million, are young adults now covered under their parents’ plan until they turn 26. That is just cynically telling young people they are getting something for free when everyone else with insurance is paying for it.
So it is not a surprise that the price of the benchmark Obamacare insurance plan is jumping an average of 25% nationwide. For the millions of Americans getting their insurance through the Obamacare marketplaces, that’s a disaster even though the blow will be cushioned by federal subsidies. And it is just an insult that Obamacare architect Jonathan Gruber went on CNN to opine that “the law is working as designed.” Apparently, the law was designed so that one in five Obamacare “beneficiaries” have exactly one insurance carrier to choose from for 2017.
The Democrats made promises for health care reform that were widely known to be laughable. To give cut-rate insurance with multiple thousand dollar deductibles to a few million people, Democrats have messed with the health care of every American, and 25% annual rate increases are just a taste of what is to come if this foolish scheme isn’t abandoned.
Jill:
So many points to argue, so little space. Expanding Medicaid has given millions access to health insurance and services, many of them children and people with jobs. To me that’s wonderful. The same is true of making it possible for children to stay on their parents’ plans until they’re 26 (and not for free, you have to pay extra). That’s a safety net for young adults who can’t find jobs, whose jobs don’t offer health insurance, or who want to start businesses. It’s also a way to broaden the pool to include generally healthier young people.
Democrats have not “messed with” the health care of millions. They are trying to fix what insurance companies, doctors, hospitals, drug companies and everyone else has spent decades messing with. They have not messed with nearly half the country that gets coverage at work, whose family premiums rose about 3% from 2015 to 2016. Or the 36% who get coverage through government plans such as Medicare and Medicaid.
Only 7% of the country buys insurance through the ACA marketplaces. It is hugely complicated and expensive. The first time I bought a policy, I had to ask a friend with a Ph.D. in health economics to sort out my options. I didn’t qualify for subsidies, and under ACA insurers are allowed to charge me three times more than a younger person. My choices were constricted — because Congress vetoed a government-run public option health plan and an option to buy in to Medicare, and because I live in Washington, D.C., a small market that attracted few companies.
And yet, before the ACA, insurers could charge whatever they wanted based on age, gender or health status. They could also restrict, cancel or deny coverage due to medical conditions that may be found in up to two-thirds of the country. I can assure you I would never have been able to get insurance — and the peace of mind that comes with knowing you can go to your doctor and weather a medical crisis without bankrupting your family — except for the ACA. It needs to be fixed, and there are ways to fix it. But first we have to agree that we need this law.
David: I feel your pain. I have gone without insurance when I was between jobs. I have paid out of pocket for prescriptions. If ever there was an industry that deserved the regulatory hammer, the health care industry is it. I just had my fourth kid but only recently wrapped up the last nagging bill dispute over kid 3.
The problems don’t come from a free market gone wild. They come from 75 years of increasing government interference that has made health care costs opaque to Americans with insurance. As health care costs became invisible, pressure to keep prices down disappeared and health care inflation got out of control. More government rules, like the 1,000- page Obamacare legislation, won’t fix that.
And Obamacare doesn’t simply regulate the 7% of Americans who get their insurance through government marketplaces. It is reshaping health insurance for all of us. And while you are right that family premiums for employerbased insurance went up slowly last year, the costs that employees are paying for health care went up faster. When government regulation squeezes one place, inflation just pops out in another.
The examples abound. Obamacare is pushing insurers to narrower networks of health care providers, which puts people in a new bind: Consumers can keep their doctors or risk a disruption in their care when they change plans. For those with serious health problems, that can be huge. If Republicans came up with a scheme to foist this choice on the sick or push poor people into subpar Medicaid plans, Democrats would be outraged. But as Democrats make all Americans’ health care more and more like Medicaid, we’re supposed to celebrate and ask for more.
President Obama has already signed 14 laws passed by the Republican Congress intended to fix aspects of Obamacare. There is no magic cure to our health care problems, so anyone who is promising that a new round of tighter rules will fix things is selling snake oil.