If you want to throw a rock at the hornet’s nest and get the conversation going, just ask people what they think about the Affordable Care Act. When you see questioning, raised eyebrows, say, “You know: ‘Obamacare.’”
The Affordable Care Act – The Patient Protection and Affordable Care Act became law under President Barack Obama on March 23, 2010.
The average American was blissfully unaware that this new law was about to polarize public opinion about the business of healthcare in the United States.
The ACA prints out to more than a staggering 20,000 pages! No wonder many elected representatives were unable to judge the pending legislation: this Act is literally mountainous in its volume.
The law itself was introduced rather quietly and approved, despite opposition from critics who prophesied that socializing the nation’s health insurance business through a federal mandate was bad business. The result would be higher insurance costs and higher healthcare fees. Both predictions have come true.
Adding insult to injury, people unwilling or unable to buy health insurance would be assessed an IRS tax penalty, collectible only through tax refunds due (and not by adding the fee to tax owed).
According to the Government Accountability Office, Obamacare was originally projected to add $6.2 trillion to the nation’s long-term deficits, despite Obama’s repeated assurances in 2009 and 2010 that it wouldn’t create a “single dime” of red ink.
The true cost of the ACA to the federal budget is a complex calculation and beyond the scope of this article. (John Mauldin presents a keen analysis of “deficit” versus “debt” in his November 2, 2016 Forbes article titled “Thanks To Obamacare, Government Debt Is Worse Than You Think.”)
Many Americans recoiled against the very idea of the ACA because it goes against our feeling that we have free will and choice, when it comes to personal matters like health insurance.
President Obama and the authors of the ACA countered that auto insurance is mandatory. Still, incidents of wrecks involving an uninsured driver are common enough to warrant “Uninsured Motorists Coverage” in most auto insurance policies.
Making a law does not ensure compliance, especially if it is a bad law.
The problem with ACA is that, although it really does help dirt-poor people get health insurance and needed treatment, it harms the middle class, especially families.
As predicted, the consumer cost for health insurance sky-rocketed. eHealth reports:
“New data shows average individual (Obamacare) health insurance premiums have increased 99% since 2013. Over the same time period, family premiums have increased 140%.”
As for what we might expect for next year, the Washington Post reported that a family of four in Virginia, the Dixons, had sticker shock earlier this month when their ACA premiums shot up from about $900 per month in 2017 to over $3,000 per month in 2018.
Most people would be happy to pay more for a useful benefit like health insurance if personal income rose proportionately. But, we all know wages have not doubled or tripled in seven years.
The current state of health insurance in the US is topsy-turvy: those who can’t afford it can get it free or at a deep discount; those who need it (older folks, especially) simply do not have the funds available to pay for it.
Health insurance applicants who earn too much money to qualify for Medicaid may not earn enough to qualify for an ACA premium discount. The only option left for this income tier is to risk remaining uninsured, and to file an IRS Form 8965, Health Coverage Exemptions, to avoid being charged the tax penalty.
The ACA system is so paperwork-laden and administratively top-heavy, for medical providers, that many have a “self-pay” rate for uninsured patients. Some provide a discount for cash payments. Some even refuse to accept any form of insurance, in order to keep their costs down.
One of President Trump’s campaign promises was to toss the ACA into the trash. He tried to do so earlier this year, but Congress failed to support Trump’s proposed replacement, The American Health Care Act (AHCA).
A March 6, 2017 Politico article by Jennifer Haberkorn explained why four Republican senators opposed the much simpler, stream-lined AHCA:
“Medicaid expansion emerged as a key friction point in the debate over scrapping the health law. Several Republicans say they’re worried that Americans who obtained coverage under the program would suddenly lose their health insurance and be left without options if the program is rolled back.”
In response to congressional resistance, Trump tweeted his plan to amend the ACA via executive order. His stated goal is to provide alternatives to the insurance marketplace set up by the ACA and offer cheaper health insurance options through association health plans to help small businesses.
Still, concerns among our elected officials about improving our national health insurance system persist. On June 22, 2017, Maureen Groppe wrote, in USA Today:
“Senate Republicans’ proposal to rewrite the Affordable Care Act would scale back federal funding for Medicaid, change the subsidies available to help low- and moderate-income people buy private insurance, end the mandate that most people buy insurance and repeal taxes that helped expand coverage to about 20 million Americans.”
On October 12, 2017, Trump created quite a stir on Capitol Hill when he halted CSR (cost sharing reduction) subsidy payments to health insurers selling Obamacare. The subsidies total about $7 billion this year, and reduce premiums for millions of lower-income Americans.
No longer will insurers get federal reimbursement for discounts on co-payments and deductibles that they are required by law to offer to low-income consumers. Insurance companies must still provide the discounts, however, so presumably, they will charge even higher premiums for coverage.
Debates pro and con the ACA aside, the underlying issue that no one is talking about is how We the People regard any form of national health insurance program, under federal mandate.
Now that the 2017 Open Enrollment Period for ACA is upon us, it is an appropriate time to decide if we want to tolerate more Socialist policies (by letting the Nanny State tell us how to run the business of healthcare) – or remain true to the Capitalist system (develop a free market system where both insurers and healthcare providers compete fairly).
For the time being, the prognosis for “affordable” healthcare looks bleak – unless you are very rich or very poor.