State Of Obamacare

I've been fortunate . I've been covered by health insurance since the day I was born. To me it seems natural and more necessary than almost any other type of insurance. Why anyone would want to deny this to their fellows is beyond my comprehension. Health care is a right, not a privilege. And don't say that we, the richest nation on the planet, can't afford it. With some adjustments to the military budget and the tax laws, we could have universal health care as does every other advanced industrial nation.

The Patient Protection and Affordable Care Act was a step in the right direction. At the time it was signed into law, nearly 50 million Americans were uninsured - many or most because they could not afford it. Single payer or some public-private mix to get truly universal coverage would have clearly been better. But the ACA is perhaps the most we could have hoped for in light of the rabid opposition to the expansion of access to medical insurance.

It's been a hard road so far. Opponents have successfully hampered its implementation (25 Republican-controlled states decided not to expand Medicaid). The startup of the government website was beset with problems. The confusion over health insurance plans that did not meet the new standards was stunning and people were ill informed to deal with the "we're cancelling your insurance" notices sent out by insurance companies.

And it is not going to get any easier. Massive amounts of money are being spent to defeat vulnerable Democrats who supported the ACA in the upcoming 2014 elections. Since September, just one group, the conservative Americans for Prosperity, has spent $20 million on anti-ACA-supporter TV ads. [NY Times, Jan. 15] There are ongoing ad campaigns aimed at convincing younger, healthier Americans not to sign up. Should they be convinced by this onslaught of negativity, premiums will necessarily go up and the rabid opponents of the ACA, who poured millions into these campaigns will say "I told you so."

Here then are some thoughts on the Affordable Care Act at the start of its first fully operational year.

The healthcare.gov rollout was inexcusably botched... The single most important piece of legislation enacted during Obama's first five years relied on a website whose development appears to have been rushed and that lacked adequate pre-startup testing. This one is on Obama and his staff. All IT projects run into problems and, as red state after red state declared their intentions not to set up state health care exchanges, the writing was on the wall. This website would be overwhelmed. Progressives should be angry with Obama for this lack of oversight. The Affordable Care Act is an acid test of the most distinguishing feature between the political philosophies of the two main political parties: Does government have a role in improving the lives of its ordinary citizens? As the title of the History Channel presentation on the NASA space program says "Failure is not an option." The botched rollout was more than what any red blooded Tea Partier or supporter of the corporate oligarchy and the 1% could have hoped for.

...but things are looking up for the healthcare.gov website. After 400 fixes, the downtime was less than 5% by the end of November and it is even better now. "Ping time" (the round-trip delay time for a computer signal) is down to 15- 50 milliseconds. The site can now handle an estimated 800,000 visits per day.

After the fixes, enrollments surged. The LA Times reported on January 13: "More than 2.1 million Americans signed up for health insurance in the last three months of 2013 through new online marketplaces created by President Obama’s health law, as a December surge in enrollment helped the initiative recover from its disastrous launch." Don't forget that one of those last three months was October which saw very few enrollments. So it appears that ACA is enrolling new customers at a rate of about 1 million per month. And there are 3 million more who "have not yet selected a plan but have filled out applications for coverage on the new insurance marketplaces since Oct. 1 and have been deemed eligible for a plan." Finally, in October and November alone approximately 3.9 million people signed up for Medicaid.  If one of the prime purposes of expanding health insurance coverage is to cover those who could not afford it, this surely has to count as a success.

Cancellation of existing policies provided another black eye for the rollout... I don't think the Administration had a clue as to the extent that insurance companies would choose to cancel policies that did not meet Affordable Care Act standards. Rather than enact the necessary provisions (e.g., coverage for prescriptions, hospitalizations and emergency room care), many insurers chose to cancel the policies.  What could have been done to prevent this from bollixing up the works at the eleventh hour as people went to a malfunctioning website after being told they would no longer have health insurance after the end of the year? Several things come to mind: grandfather policies from say January 1, 2013; a notification period of no less than 6 months that your policy was being cancelled; a clear explanation by the President as to what "if you are happy with your existing policy" actually meant (policies in effect as of March 2010 were "grandfathered") ; and, of course, a fully functioning website.

 

...but Obamacare success stories are getting some press.

The Daily Beast, Oct.23 - "The Obamacare Success Stories: From a retired business owner in Arkansas to a young freelance filmmaker in Hollywood, Eleanor Clift highlights a few of the people the media has found who are happy to have Obamacare."

The Daily Kos, Nov. 4 -"Obamacare 'rate shock' victim changes her mind, calls the law a 'blessing in disguise'

TPM,Nov.25 - looks at how "Kentucky Uninsured React To SecuringHealth Care Coverage Under Obamacare"

TheDaily Kos, Dec. 10 -"What Republicans don't want: Florida woman cries tears of joyafter getting $3.19 Obamacare policy"

The Hill, Dec. 29 - "Five states with ObamaCare success"

The most obvious, but surely not the last attempt to defund, repeal or sabotage the Affordable Care Act was the phony debt-ceiling crisis manufactured last year by Republicans. The government was shutdown by the extremists who control the Republican Party. Though it failed miserably, people have a short memory and Republicans' approval ratings are increasing. There's a well-funded campaign in the run-up to the 2014 elections aimed at defeating Democratic legislators who supported the ACA.

There are the advertisements urging young people to opt out. A Yahoo News November 11 headline of an article reporting the shenanigans at the University of Miami read "Anti-Obamacare group entices students with models and a boozy party." What's the reasoning here? As the Yahoo post explains "You see, in order for the health care law to function, lots of healthy, young people must sign up for the exchanges to subsidize older, sicker insurance seekers. So conservative groups are spending a lot of money to convince them not to sign up." Now this logic should outrage any fair-minded person. The absence of a healthier cohort in a health insurance plan raises the rates for everyone. Expect an all-out blitz on this front in the coming months.

Legal challenges may cripple the legislation yet.   It's not over yet in the courts as several legal challenges wend their way towards the Supreme Court.  As reported in the LA Times "The new suits take aim at the parts of the law that offer subsidies to those who are above the poverty level but still may struggle to pay for insurance." 

The most threatening of these lawsuits borders on nit-picking insanity - whether insurance obtained on the Federal health care exchange (as opposed to State exchanges) is eligible for subsidies.  Wording issues such as this one would usually be ironed out between the Administration and Congress.  But in today's hyper-partisan environment, no cooperation can be expected. If this law suit succeeds, then no state without its own exchange would be able to participate in the Federal subsidies. There are 36 states without their own exchanges. Such a ruling would effectively dismantle the Affordable Care Act in these states.

Now for the good news. On January 15, a Federal District Court judge ruled in favor of the Affordable Care Act.  Reuters reports that the judge "upheld subsidies at the heart of President Barack Obama's healthcare overhaul, rejecting one of the main legal challenges to the policy by conservatives opposed to an expansion of the federal government. A ruling in favor of a lawsuit brought by individuals and businesses in Texas, Kansas, Missouri, Tennessee, West Virginia and Virginia would have crippled the implementation of the law by making health insurance unaffordable for many people.  In his ruling, U.S. District Judge Paul Friedman in Washington D.C. wrote that Congress clearly intended to make the subsidies available nationwide under the 2010 Patient Protection and Affordable Care Act. 'There is evidence throughout the statute of Congress's desire to ensure broad access to affordable health coverage,' the judge wrote." 

The respite might be temporary if the plaintiffs take the case to the Supreme Court. But for now, the greatest legal challenge has been overcome.  Stay tuned.  As a great philosopher once said, "It ain't over 'til it's over."

Other Links

Medicaid expansion is going forward in just half of the states.  If every state agreed, more than 20 million Americans could be insured in the next decade.  Here's a link to the Medicaid expansion webpage on the ObamaCare Facts website.