No, the ACA is NOT Failing

I have to admit, I am getting a little tired of the hyperbole that tries to pass for journalism these days. It’s getting really, really old. For example, there is this “analysis”from Monday’s New York Times about the Affordable Care Act. The headline, “Ailing Obama Health Care Act May Have to Change to Survive,” has a breathless quality to it, until you realize two things:

  1. Everyone knows Obamacare needs to change and;
  2. It’s more than surviving, it’s thriving. It’s only been in effect, for the most part, for three years, and many parts don’t kick in until 2018.

Look at the first couple of paragraphs:

The fierce struggle to enact and carry out the Affordable Care Act was supposed to put an end to 75 years of fighting for a health care system to insure all Americans. Instead, the law’s troubles could make it just a way station on the road to another, more stable health care system, the shape of which could be determined on Election Day.

Seeing a lack of competition in many of the health law’s online insurance marketplaces, Hillary Clinton, President Obama and much of the Democratic Party are calling for more government, not less.

The departing president, the woman who seeks to replace him and nearly one-third of the Senate have endorsed a new government-sponsored health plan, the so-called public option, to give consumers an additional choice. A significant number of Democrats, for whom Senator Bernie Sanders spoke in the primaries, favor a single-payer arrangement, which could take the form of Medicare for all.

The article starts with pure hyperbolic nonsense. No one in their right mind thought we were going to get universal health care in one bill. It was never meant to be  anything more than a “way station” on the path to universal healthcare. I would also point out that the President, “the woman who seeks to replace him” (her name is Hillary Clinton, genius) and more than one-third of the Senate have always wanted a public option as an alternative to private insurance. It was even in the original bill. The only reason it is no longer there is because too many unicorn progressives couldn’t agree on what a “public option” would entail and they watched as the Republicans killed it with amendments, while they were running around like Chicken Littles. Yes, that’s right; the people who whine the loudest about the “public option” actually killed a public option in the first place.

As for the single-payer crack, it’s not a “significant number of Democrats” at all, as evidenced by the fact that Hillary Clinton received three-fifths of primary votes. There is no way the American people will go along with ditching the entire system as it stands now and replacing it with a “government-run” system, especially not after we have allowed Republicans to have way too much influence over government and the electorate since 1981.

Overall, the implication seems to be that the Affordable Care Act is somehow doomed and will die soon if someone doesn’t “save” it. That’s ridiculous. Upwards of 20 million more people have health insurance now; the rate of uninsured has been cut in half. Not only that, but the 90 percent of Americans who have health insurance have more coverage than ever before. While there is a lot of election year posturing about soaring premium rates, it could possibly be a ploy by insurance options to get a public option in place. While insurance companies will never admit it, a public option would actually make them more profitable, by spreading risk.

In other words, insurance companies and Republicans have a vested interest in making you think your insurance will suddenly double. First of all, sign-ups for next year won’t even start until about a week before the election, so prices haven’t been set necessarily. Also (and this is important to remember), the only prices that are going up are those on the exchanges and only about 6-8% of insured get insurance from the exchanges. The vast majority of the insured get it through their employers and there is no way many companies will sit still for a premium that doubles in one year, especially since there is rarely a change in their risk pool, unless they let go all of the healthy people and replace them with employees with health problems.

Over the years since the ACA started to take effect, health care inflation is less than before the ACA. Even if rates doubled this year, they are still less than they would have been without Obamacare. What is happening now it what we knew would happen all along; this is insurance companies trying to get the government to open up a public health insurance system to take some of the pressure off. Keep in mind, while some large insurance companies are threatening to enact major increases, anything they collect above the 15-20% they’re allowed to use for expenses other than health care will have to be rebated to the policy holders. By then, if we’re smart, we will make sure we elect a Democratic majority that will happily pass a public option to provide more competition and also to take some of the risk pool pressure out of the private insurance companies. Both of those will reduce pricing pressure on everyone.

As for the contention made by the column’s author, there is no evidence that “the insurance lobby” is mobilizing to kill a possible public option. For one thing, a public option won’t happen as long as Republicans have a majority in either the House or the Senate, so it would be a waste of time. Yes, they’re lobbying against Jeff Merkley’s resolution to declare a public option a necessity, but it seems to be a token effort, at best. They are only concerned about the exchanges, which are actually a small portion of the health insurance market. Besides, if they were really so concerned about a public option proposal, why would they be threatening to hike rates so much? That’s the most surefire way to bring about a strong public option.

The ACA is not in any trouble, really. Not now, and not for a while. There will be some stress and strain on the exchanges, but that was predicted from the very beginning. You can’t add 20-25 million people to the rolls of the insured, many of whom have been without insurance and access to healthcare for many years, and not expect an uptick in costs. It was always going to happen, no matter what. That said, though, if you are worried about the future of health insurance, especially if you envision a “single-payer” system sometime, you have to know that you can’t vote your privilege and cast wasted votes for third parties and expect to ever get there. Be realistic; if you want a single-payer system, you will have to work toward that, and you sure as hell will only get there via long-term Democratic majorities. And not just in Congress, but everywhere.

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