When Congress approved the Affordable Care Act in 2009, it did so at great political cost: to the Democrats who voted for it and to President Barack Obama who championed it. That was in large part owed to a line of rhetoric – wholly untrue – that the law would place Americans’ health care under governmental control. What the measure did was require that all Americans procure insurance coverage and compelled insurance companies to dispense with their discriminatory practices of refusing coverage to those with pre-existing conditions. Further, it provided subsidies for those who could not afford insurance and expanded eligibility for Medicaid – first to be federally funded and then taken over by the states. These were major gains in extending insurance coverage to the growing number of uninsured Americans that prompted the Affordable Care Act’s inception, and by that measure, Obamacare is working well.
What the health care bill did not do – nor could it have, given the vehemence with which it was opposed – was anything to control the rising cost of health care in general, or insurance coverage in particular. And by that measure, health care is not improving. While more Americans now carry health insurance, many still find the premiums unaffordable, the coverage lacking, and the cost of services rendered to be out of reach. That is large and growing problem, to be sure, but the Affordable Care Act is only the culprit in so much as it did not address cost control when it was passed.
Colorado’s statistics are allegorical of Obamacare’s successes and shortcomings. The 2015 open enrollment period for insurance in 2016 is under way and thus far, 13,414 people have signed up – a significant increase from the 9,606 Coloradans who enrolled for private insurance during the same period last year. That boost indicates that the push for more individuals to have insurance coverage – either privately, through Medicaid or Colorado’s Children’s Health Plan Plus program – is working. That is encouraging as far as it goes.
Less so is the fact that insurance costs for 2016 are rising – seven percent statewide on average, compared to 1.2 for 2015 rates – but dramatically so on the rural Western Slope where premiums for 2016 coverage will increase 26 percent. That is an alarming and prohibitive hike that will challenge many rural residents’ bottom lines. It is also indicative of health reform’s unfinished business.
The premise behind requiring all Americans to carry health insurance was that by increasing the risk pool, insurers would be able to bring rates down thanks to the influx of healthy, younger individuals who formerly went without insurance. That has yet to occur in the manner policymakers had hoped. While the rationale was sensible enough, the Affordable Care Act did not compel insurers to actualize this prediction, nor has the cost of health care itself – for doctor and hospital visits, lab work, procedures and diagnostics – adjusted to increase affordability. Those are the larger unsolved problems of health care in the United States that Obamacare has yet to answer, and a growing pool of insured Americans is doing little to change.