I read recently that over two million Americans have signed up for health care insurance under the Affordable Care Act, better known as Obamacare, either through the federal website or through the state health exchange websites. The government's health care website is working better now and many people who need insurance are finally able to get it. As the law has been unveiled over the past few years, it's benefits and flaws have become more apparent. Both liberal and conservative critics rightly point out problems that have ensued because of the law. Obamacare is not a perfect law, but there are more good things about the law than bad things. I thought I'd write this blog because in the past two months I've had a lot of conversations about Obamacare with friends, relatives and even strangers.
Obamacare has two basic premises in the hopes of getting uninsured people health insurance at a relatively low cost. One thing that Obamacare assumes is that if enough insurance companies participate in each of the state health exchanges, it'll create competition that will drive down insurance costs. The other thing that Obamacare assumes is that if enough young people sign up for insurance through the state exchanges, insurance companies will be able to spread the cost of accepting people with pre-existing conditions.
Both liberal and conservative critics ask two questions. One of the questions is this: what happens to states that have only one or two insurance companies participating in the state health exchanges? Some states are dominated by only one or two insurance companies, and in that situation, there is no competition to drive down costs. This is one of the reasons why liberals fought so vociferously in 2009 for a government public option. For those states that have only one or two insurance companies in the state exchanges, a public option would be a choice for the state consumers and could be another way to drive down costs. John McCain had another idea: allow people to cross state borders to buy out-of-state insurance.
The other question that liberal and conservative critics ask is this: what if a large number of young people take a penalty rather than sign up for insurance? If this happens, then insurance companies would have to raise premiums to make up for the higher cost of accepting people with pre-existing conditions. With so many variables involved to make Obamacare a success, liberals were worried that it made the Affordable Care Act an easy law to sabotage. And that is what Republicans have been trying to do for the past few years.
It doesn't make sense though, for Republicans to try to sabotage the state health exchanges, since state exchanges are a central part of Representative Paul Ryan's alternative health care proposals. According to an article by Ezra Klein for the Washington Post, both the Affordable Care Act and Paul Ryan's health care plans (that act as the Republican alternative to Obamacare) are based on the same principles. He wrote:
Let’s play a game. I’ll describe a health-care bill to you. Then you tell me if I’m describing President Obama’s Affordable Care Act or the budget released this week by Rep. Paul Ryan (R-Wis.).
The bill works like this: The federal government subsidizes Americans to participate in health insurance markets known as “exchanges.” Inside these exchanges, insurers can’t discriminate based on pre-existing conditions. Individuals can choose to go without insurance, but if they do so, they pay a penalty. To keep premium costs down, the government ties the size of the subsidy to the second-least-expensive plan in the market — a process known as “competitive bidding,” which encourages consumers to choose cheaper plans.
This is, of course, a trick question. That paragraph describes both the Affordable Care Act and Ryan’s proposed Medicare reforms. The insurance markets in both plans are essentially identical.
Sam Baker wrote for the National Journal:
But had Mitt Romney won in 2012 and let Paul Ryan have his way with Medicare, Republicans would be on the other side of the fence, trying to defend a health care overhaul that produced a nearly identical suite of horror stories.
That's because, despite the political chasm between them—and though neither will admit it—Obama and Ryan are pushing similar policies in the bid to change the U.S. health system. Both rely on private insurance, sold through a competitive exchange, with help from a government subsidy.
And though they apply it to different populations, both programs share a fundamental conceit: They move a big group of people into the private insurance market. Both Obama and Ryan argue their overhaul would improve the country as a whole, but neither can escape the reality that in a shift of that size, some people will lose out.
And each plan's losers would have similar stories to tell.
Instead of trying to tear down the whole of the Affordable Care Act, it seems to me that the better course for the Republicans to make would be to change the parts of the law that they don't like. Democrats should also work to change the parts of the law that need to be fixed. Liberal Democrats voted for the law, but many would've preferred a plan with a Public Option or would've preferred a Single Payer Plan. They supported the Affordable Care Act because, despite its imperfections, it'll help a large number of uninsured Americans gain access to health care insurance.
It's the nature of the compromises and give-and-take of crafting a bill that any law will have things that a person will not like. That's just the nature of the democratic process. When a law is passed and as time passed by, legislators then work on fixing the flaws or unintended consequences that unfold from the law. That's what has happened with legislation like Social Security and Medicare. Legislation was seen as a collaborative process where common ground is sought, the concerns of different groups are addressed and opposing sides are committed to working out their problems together. The democratic process is like that Rolling Stones song: you can't always get what you want, but if you try sometime, you get what you need.
Personally I think the Affordable Care Act should be given a chance to work. I acknowledge that the law has its flaws. I think, though, that the good things that come out of the Affordable Care Act outweigh the bad things. A health exchange has worked for Switzerland and Massachussetts in covering its citizens at a lower cost. For the states that have many insurance companies participating in their state health exchange and have many people signing up for insurance, I think Obamacare has a good chance of succeeding in its goals.
The Henry J. Kaiser Foundation Video: "Health Reform Hits Main Street" that explains the new health care reform law
How to choose a plan in the Health Insurance Marketplace
"How to Get Obamacare" is a Free Video Guide to Enrolling on Healthcare.gov Health Insurance Marketplace Exchange brought to you by Insureacare