I wish I could fault Trump for not knowing what the ACA, otherwise known as “Obamacare,” is and what it does, but he’s getting his talking points from the ignoramuses on Fox News and right-wing talk radio, and they don’t know what it is, either.
At a Florida campaign stop at one of his properties yesterday (which I’m sure he’s paying himself for), Trump basically proved that he has no idea what the ACA does. Not even a hint. Now, we all know that many of the people who sign up on the exchanges are facing premium increases of about 25%. But what does that mean?
First off, we’re not talking about most people. The vast majority of people with insurance get it through their employers. They might see an increase, but it’s not likely to be anywhere near 25%, unless your employer is a really bad negotiator. More than 90% of the insured are covered that way. The people affected (kind of) are those who are not covered by an employer and have to buy insurance through the exchanges. That is a total of 13.8 million people, according to estimates.
However, see that (kind of) above? I put that there for a reason. You see, everyone who makes up to 400% of the federal poverty threshold – meaning everyone out of that 13.8 million who have families and make less than about $97,000 per year – are subject to out-of-pocket premium limits and receive a subsidy to cover their premiums. What that means is, almost all of those 13.8 million people will see an increase that is roughly the same as the rate of inflation. That means, most families will see increases of 3-4%, at most. Not only that, but that level of premium inflation may increase the level of the subsidy and the cutoff, so it’s possible some people may see an actual reduction in premiums.
Another thing to keep in mind is that, since the ACA took effect, the average rate of increase is still well below the rate of increase in the previous 20 years. And this was actually predicted by the Congressional Budget Office when the bill was being debated in Congress. This should not surprise anyone. When you add a lot of sick people to the rolls who previously had no insurance, of course there will be a spike at the beginning. As time goes on, that will even out.
The problem is, Republicans have wanted to kill the ACA ever since it was passed. The problem is, they don’t even know what it is. When Trump claimed yesterday that “all of my employees are having a tremendous problem with Obamacare” (Source), he demonstrated that he has no clue what “Obamacare” is. IF his employees are having any kind of problem (he said it was due to huge premium hikes), it’s because his HR people aren’t very good at negotiation. And when he went onto Fox News last night and said he didn’t “use much Obamacare because it is so bad for the people they can’t afford it,” he once again demonstrated he has no idea what it is. Here’s exactly what he said:
Trump on Fox: “I don’t use much ObamaCare, I must be honest with you, because it is so bad for the people and they can’t afford it.” pic.twitter.com/BQXAq1vsai
— Sopan Deb (@SopanDeb) October 25, 2016
See, the ACA isn’t an insurance plan. It is a legal structure that creates significant regulation on insurance. The insurance itself is provided by health insurance companies; the same ones who have been providing insurance all along. The ACA doesn’t change the fact that most people get their heavily subsidized insurance through their employers. It also doesn’t change the fact that everyone over the age of 65 had access to Medicare insurance and they can fill in most the gaps in Medicare insurance for about $109 per month extra, if they have means and for less if they don’t. Trump is eligible for Medicare, so “Obamacare” wouldn’t apply to him, anyway, even if it was what he imagines it to be.
The ACA sought to plug many of the holes in our old system that prevented people from getting the coverage they needed. People were routinely denied coverage for little or no reason or they were dumped into an unregulated individual market and forced to take whatever plan they could afford, even if it didn’t cover anything. The ACA set minimum standards for health insurance, it prevented people from being dropped from their plan, it prevented people from being denied insurance and it removed coverage limits. It also set standards that providers must follow to receive payment, which has improved the quality of healthcare and made it less volume-oriented.
There are all sorts of stories about increases in premiums that are beyond the pale and you should not believe them. I saw one this morning in which someone tried to claim his family premium was set to double to $25,000 per year, but there isn’t an individual plan in the country that comes close to that, unless it’s a premium plan that was chosen over a less expensive plan because the individual could afford it. The 25% average increase is for the exchanges, which are for people who have no other resource for health insurance. And the overwhelming majority of them will get a subsidy.