The Affordable Care Act, or Obamacare if you choose, is entering its fourth year. After watching it for the past three years, I believe it’s time to ask whether its working or not, is it a success, and has it provided affordable health insurance and healthcare as promised?
Success can be measured using any number of measurements or metrics. One metric being touted by the current administration is 13.8 million Americans are expected to enroll in one of the health insurance plans offered on the exchange. Another metric officials point to is the uninsured rate is the lowest in our nation’s history, less than 9%.
Despite these two numbers, there are other metrics which paint a very different picture.
- In 2014, the first year health insurance coverage was required, the IRS reported 8.1 million people chose to pay the non-participation penalty rather than have health insurance.
- In 2015 5.6 million chose to pay the penalty and forgo health insurance.
- Premiums continue to climb, in some cases, up to 50% for 2017 over 2016.
- The number of companies participating in the exchange has dropped by almost 50% in Texas, 19 last year to 10 for 2017.
- Copayments and deductibles continue to rise for individuals and families.
If none of these trends improves in the coming years I can only imagine most people will be paying a lot for what amounts to catastrophic care.
Change is needed but what change? Here are a few paths I see available to us. Whether they make sense or not is up to you.
No Change: Leave the program intact as it is and find some way to entice greater participation by individuals, families, and health insurance companies. Greater participation by all will spread the risk and may lead to more affordable options.
Repeal the ACA: Many Republicans want to repeal Obamacare or defund it. Several candidates made this a central part of their platform prior to falling out of the presidential race. I believe this will result in millions of people being denied coverage due to poor health and pre-existing solutions. I also am reluctant to believe health insurance costs and out of pocket payments will decrease to the level present before Obamacare was implemented.
Single Payer Solution: Within the Democratic party, there are many who believe a single payer solution will resolve the issues of who’s participating on the exchange and slow the cost escalation for participants. This may make health insurance more affordable, but will it make health care more affordable?
Increase Penalty: Some believe the tax penalty for not having health insurance should increase to help force greater participation by healthier, younger people. Such a solution may reduce the risk in the current participant pool and spread cost more equitably in the short run, but what are its long-term consequences?
Hybrid Approach: Repeal the ACA allowing those who had coverage prior to its implementation to return to the open market. For individuals and families who couldn’t get insurance prior to the ACA’s implementation, broaden Medicaid, Medicare, or some new program, to acquire health insurance on a rate which scales up or down based on after tax income.
It will be interesting to see who wins the presidential, congressional, and senate races in next week’s election. That may result in change one way or the other. What I’m curious about is if you were king for a day, what would you do? Share your solution with me on my Facebook, Google +, and LinkedIn pages. I’d love to hear from you!