Vail Daily column: Understanding Obamacare
Editor’s note: This letter was submitted on June 21, the day before the Senate was scheduled to release a highlight of its plan to replace Obamacare.
Earlier in 2016, I attempted to characterize with an acronym the Affordable Care Act (ACA), known politically as “Obamacare.” Firstly, the Obama administration did a terrible job of explaining the ACA. Further, the necessary adjustments to any large, complex program were never made due to political gridlock. Finally, most politicians on both sides of the issue couldn’t mutter more than one sentence about its features — noting today, June 21, that’s likely up to three sentences.
So with some additional insight, I’ll attempt to re-characterize the really key points of Obamacare where HELP AND TIPS are the benefits, with AND calling out financial underpinnings intended to support the program.
• H — Help with premiums: Many above the Medicaid-eligible level can afford health insurance via a sliding scale of subsidies based on their income.
• E — Expansion of Medicaid: States given the option to get more funds, for a period of time, to get more enrollees. Some states accepted the monies (Colorado did) and some did not, for a variety of political and other reasons.
• L — Leaving young folks on parents’ health policy till age 26: Every politician’s top of the list to save. It’s something they can understand and remember.
• P — Pre-existing conditions not a penalty: Again, high on the list of most politicians, as its understandable. This issue also calls out the features of removing lifetime caps, no higher premiums for females and not allowing pre-Medicare seniors to pay more than three times what younger folks are charged for their insurance premiums.
• A — Affordability with real competition amongst insurance companies: Clearly, this has not worked out, with skyrocketing insurance premiums, increased deductibles and many insurance companies leaving states.
The reasons are: 1) Not enough healthy folks signing up, 2) Some gamesmanship to force federal government approval of combining some of the largest insurance companies and 3) Not knowing what will come next. The favorite solution is selling insurance across state lines, but this runs straight into the “states’ rights” issue, as each state has its own insurance commissions who do not take kindly to federal government intervention.
• N — Notion that all Americans should have health insurance: Driven by the negative “incentive” to get insured or face a penalty. Clearly the penalty must go, but are touted positive incentives enough to do much of anything? The big picture intent is to reduce using hospital emergency rooms as primary-care facilities and reduce personal bankruptcies due to medical expenses.
• D — Detailed, long list of additional revenue from taxes, fees, interdepartmental transfers, etc.: For example: 1) for those already on Medicare, the monthly Medicare “B” premiums are somewhat higher for higher-income folks, 2) various taxes on medical equipment suppliers, etc., and 3) $700 billion more than 10 years projected savings from Medicare transferred to assist Affordable Care Act.
• T — Transferability of insurance, allowing employment mobility, annual shopping around, etc.: Of absolute importance to the notion of more job growth to allow: 1) job changes not based on insurance benefits, 2) would-be entrepreneurs willing to go out on their own without their decisions again tied to health benefits and 3) allowing folks to freely move between being self-employed, “independent contractors” and fully/directly working for someone else.
• I — Insurance 10 essential health benefits: The cynic would say it’s a mix of “necessities” (e.g. hospitalization), “niceties” (e.g. maternity) and “you bet your country’s future” (mental health and opioid treatment).
• P — Preventive health screening covered: This is the one thing that might yet save the nation’s health system, with our diabetes epidemic — noting it is one of the “10 essentials.”
• S — Seniors with Medicare: The Affordable Care Act is gradually closing the “doughnut hole” in Medicare Part D drug plan. The planned closure is 2020, noting the increasing drug prices force more folks into the donut hole, where the government soon will pay much of these increased costs (nice).
This Affordable Care Act characterization clearly misses a lot of features (viewed as good or bad by some) and has errors. But if you identify these aspects, then you clearly know much more than your typical elected representatives. So as the planned Obamacare replacements come out, channel these thoughts to your representatives with your insights.
Paul Rondeau is a Vail resident.