Healthy individuals, whose participation is needed to cover those who require care, have purchased lower-cost plans, leaving little excess. Families are doing much the same, risking financial stress by signing up for plans with higher deductibles and higher co-pays.
Insurance companies, which were eager to add millions of uninsured to their rolls with premiums underwritten by the federal government, lobbied intensely for the ACA. They have since discovered that the previously uninsured have needed more care than expected. Emergency room bills, which had been absorbed by hospitals, now fall on the backs of the insurance companies.
Insurance companies, stung by their miscalculations that have produced early losses, have backed out of the state exchanges originally designed to help provide choices in coverage and prices. The choices have almost disappeared, and premiums are being increased.
Meanwhile, segments of the medical profession are largely doing just fine. Look at the number of standalone outpatient care facilities which line the highways through urban centers.
The Affordable Care Act was a game-changing effort to provide insurance for most of the uninsured, and to include several provisions that made good sense for individuals. Mandating the coverage of pre-existing conditions was critical, and being able to keep children through age 26 on the family policy, another.
As to the exchanges, states had the choice whether to create their own or to use the federal government’s. Some state exchanges have done better than others. So, too, the choice whether to expand Medicaid coverage, encouraged by full federal reimbursement in the beginning years. The states’ share of that plan is becoming a large percentage of their budgets.
What can be done differently? Those who would do away with Obamacare and who advocate for tax incentives to encourage individuals to set aside funds for their medical needs, and who champion the promise of cost comparison shopping, are only touching a very small slice of what individuals and families can face. A health care savings account and decisions by the uninformed would be swallowed up by the size and complexity of most health care procedures.
What will follow the ACA? That conversation will not occur under the current president. He and his political party have too great a stake in the current plan.
Here in Colorado the Colorado Care Act, on the November ballot, provides some ideas. It is a plan that has no deductibles or co-pays and no need to be concerned about a 27-year-old child’s coverage. For those on Medicare, it would cover their paid supplements. For the small- and medium-sized employer it eliminates the need for a human resources staffer to try to be an expert on insurance coverage. In fact, ColoradoCare will mostly do away with insurance companies.
For those who want to do away with Obamacare in Colorado, ColoradoCare would do that. And Colorado Care’s decision makers would be Coloradans, not from Washington D.C., if that is important.
But too many of the specifics would be in the state’s constitution, virtually unchangeable with experimentation, including tax rates and leadership composition. For such a major change in policy, that is too limiting. Consider its provisions, but do not put it into the constitution.
The great experiment that the ACA has brought was well-meaning and needed. It broke open a long-held system of insurance provision that was inadequate and punishing. We hope that the next administration will improve on the ACA, taking it in a more successful direction.