WASHINGTON – The President of the United States recently allowed that he has proved tardy in offering his long-awaited replacement for the Affordable Care Act because “nobody knew that health care could be so complicated,’’ sounding for all the world like an eight-year-old confronting theoretical physics for the first time.
The comment is yet another example of those whoppers Donald J. Trump is wont to tell. Everybody, including The Donald himself, knew health care policy was an excruciatingly difficult river to ford long before he set his sights on deep-sixing the present platform developed under the watchful eye of his predecessor, former President Barack Obama, which has actually worked quite well — in fact, better than expected.
So if Trump thinks health care is complicated, wait until he tries to sell the American public on a replacement package several ticks below what is now available. In other words, the man who fancies himself the master salesman is positioning himself to convince the citizenry that dirt does, indeed, taste like ice cream.
None of the repeal-and-replace outlines being batted around like shuttlecocks over a badminton net by Trump and associated members of his Republican Party approach the sort of health care coverage assurances provided by what has come to be known as Obamacare, giving the lie to promises of serving up something bigger and better.
Trump may promise “insurance for everybody’’ but his vow, as usual doesn’t hold water. An analysis of a plan pieced together by GOP congressional leaders, replete with their favored inducements of tax credits and savings accounts, suggested that millions could lose coverage under the proposal favored by House Speaker Paul Ryan, R-WI, a burgeoning fraud if there ever was one. The proposal would, among other disreputable things, eliminate subsidies for people to obtain coverage and phase out federal funds for states to expand Medicaid in 2020.
Republicans have dedicated a lot of time and effort to degrade Obamacare as a failure, a word used by Gov. Matt Bevin, among others, a curious description since 22 million Americans – 500,000 in Kentucky — who didn’t have health insurance have been able to gain coverage as a result of the ACA. The commonwealth Bevin ostensibly leads, has seen its uninsured rate drop from 20.4 percent in 2013 to 7.8 percent in 2016.
Some fiasco. Bevin could only hope to be such a failure. Unfortunately he’s taking the usual route.
Making insurance accessible under Obamacare is costing less than anticipated. The price tag ain’t cheap — $1.207 trillion through 2025 — but that’s down from the $1.35 trillion estimated in April 2014. Steps could be taken to make the program even more economically viable but Republicans won’t play ball – favoring repeal and replacing the ACA with an inferior product rather than agree to fix what already is in place.
Regardless, the U.S. health care inflation rate currently rests at 3.86 percent – higher than it was last year but lower than the long-term average of 5.4 percent, much of which was built up in the years prior to Obamacare.
So Republicans have painted themselves in the corner. Much of their raison d’etre for the past seven years is wielding the sword to kill Obamacare, a goal that has always leaned on politics more than substance. Now they’re the chasing dog that finally caught the car. What the hell are they going to do with it?
Complicating matters even further is the Affordable Care Act is gaining in public popularity and acceptance. The latest Kaiser Health Tracking Poll finds attitudes regarding Obamacare are shifting. The 48 percent with a favorable opinion toward the law represents the highest level of support since Kaiser began seeking the public’s opinion beginning in 2010. The growth, according to the poll, is largely being driven by a change in the views of independents. Half of them now view the law favorably.
Much of that progress can be attributed to the fact that the sky has not fallen, despite the incessant warnings of Chicken Little Republicans. That isn’t keeping them from giving it the old college try. And of course the leading chicken in all this is old friend Senate Republican Leader Mitch McConnell, of Louisville.
In a recent op-ed, McConnell asserted Obamacare “has become a mess in Kentucky’’ and blathered that costs are soaring.
“In our state, premiums are rising by as much as 47 percent this year alone,’’ he said. “The damage of this disastrous law injected instability into the insurance market, and now families across the state are stuck paying the price. It’s now clear that the so-called Affordable Care Act is anything but affordable.’’
Indeed, the Department of Health and Human Services reported last October that premiums rose an average of 25 percent in the states that use the Healthcare.gov marketplace that permits individuals to purchase plans. That comes after 2016, when premiums rose by 7 percent and 3 percent in 2015 – both well below historical standards.
So McConnell is hyping a one-year fluctuation — characterized in an analysis by the Urban Institute as a short-term correction — after several years of below average increases. The spike came about for the most part because portions of the law designed to keep costs artificially low ended. McConnell and the GOP Congress could have moved to renew those provisions, which might have maintained those low levels, but they turned their collective back on premiums payers.
What the senator further failed to note is that enrollment for 2017 grew despite higher premiums and fear the fear that McConnell and his ilk will move to repeal the law. About 6.4 million people found health care insurance through the marketplace this year – about 400,000 more than 2016. Regardless, more than 70 percent of those who purchase coverage through the exchanges receive subsidies – a provision the Republican leadership hopes to kill. Those getting the subsidies won’t face any premium increases since their financial stake is already fixed.
Obamacare was never destined to run perfectly from the get-go and, indeed, it hasn’t. The law made significant changes – those with pre-existing conditions can no longer be denied coverage, for instance, and pregnancy coverage was mandated. That was going to create some pitfalls that required additional action.
A Brookings Institution study published last July found that even with this year’s spike in premiums rates remain lower than they would have been sans Obamacare. Premiums would have to rise by more than 44 percent to better the rates currently under the ACA.
Even that wasn’t enough. McConnell waved the bloody shirt again about those unable to keep their physician, attempting to transform it into the biggest miscarriage of justice since Dreyfus. But he did raise one semi-legitimate point – some insurance companies are moving out of Kentucky and other states, leaving those looking to purchase insurance with fewer options.
“Across the country, choices of plans and providers are dwindling,’’ McConnell wrote. “In Kentucky’s 120 counties, 54 have only one choice for an insurance provider in the marketplace. Having only one option is really having no option at all.’’
One choice isn’t sufficient, but it is better than none at all if you get sick. But that’s beside the point. Two researchers, Nicholas Bagley of the University of Michigan Law School and Mike Adelberg, a former Medicare and Medicaid official, found that the risk-management programs patched into the ACA to help insurers through the transition to a regulated insurance pool have not performed as hoped, costing insurance companies more than anticipated, thus forcing some to move on.
Bagley and Adelberg said a big part of the problem is the refusal of Congress to get involved, and that lies with the Senate Republican Leader from Louisville. Obamacare was never destined to run perfectly from the get-go and, indeed, it hasn’t. The law made significant changes – those with pre-existing conditions can no longer be denied coverage, for instance, and pregnancy coverage was mandated. That was going to create some pitfalls that required additional action.
The insurance industry had no way of telling how those new mandates were going to affect the bottom line. Some didn’t fare well. Rather than deal with the issue with adjustments in the reinsurance and risk adjustment markets, congressional Republicans donned the blinders and ear plugs, exacerbating the situation. Then, like Victor Frankenstein, they damned the result of their own creation.
Former Gov. Steve Beshear, who led the state’s successful implementation of the Affordable Care Act, was chosen this week to give the Democratic response to Trump’s initial appearance before a joint session of Congress. In his presentation, Beshear maintained that ongoing Republican opposition to Obamacare stems from its “belief that folks at the lower end of the economic ladder just don’t deserve health care. That it is somehow their fault that their employer doesn’t offer insurance or that they can’t afford to buy expensive health plans.’’
Speaking directly to Trump, Beshear reminded the president that “this isn’t a game, it’s life and death for people.’’
Bevin, McConnell and the rest may want to remember that as well.
Washington correspondent Bill Straub served 11 years as the Frankfort Bureau chief for The Kentucky Post. He also is the former White House/political correspondent for Scripps Howard News Service. A member of the Kentucky Journalism Hall of Fame, he currently resides in Silver Spring, Maryland, and writes frequently about the federal government and politics. Email him at williamgstraub@gmail.com.
I admit to not being any kind of expert on the ACA but I do believe that everyone should have health insurance. Probably the only real solution is to cut the insurance companies out of the picture completely and have an expanded Medicare system that covers everyone. That won’t happen as long as there is a Republican standing. An alternative, does anyone know what the ratio is between what the government collects in penalties and what it pays the insurance companies to subsidize the lower income folks. Maybe that pot needs to be sweetened.