A reality check on the ACA
Published December 4, 2013
I like a media feeding frenzy as much as the next guy, but, geez, is it too much to expect even minimum standards?
It’s clearly too much to expect when it comes to the federal government’s troubled online marketplace for health insurance, which was developed as a key part of the multi-faceted Patient Protection and Affordable Care Act of 2010 (also called the ACA or Obamacare).
The marketplace launched on Oct. 1 as a separate section of the massive HealthCare.gov website, and it was an instant mess. Far too many people saw their site registrations vanish into cyberspace, web pages took eons to load (if at all), error messages froze on users’ computer screens, the system couldn’t display policy comparisons, information got lost or mangled in transmission to government agencies and insurance companies and state Medicaid evaluations took forever. Things seemed to improve considerably after an emergency six-week repair project ordered by President Barack Obama and a quasi-relaunch on Dec. 1. Independent confirmation of administration data, however, has yet to appear.
The ACA, of course, has long been ground zero for ideological and political dispute. As of October 1 –- going on four years since it became law and more than a year since it passed muster at the U.S. Supreme Court — Republicans in the House of Representatives had voted 46 times to repeal it, delay provisions or cut its funding.
So it was hardly a surprise that Obamacare opponents pounced gleefully when the online marketplace malfunctioned badly on launch and for weeks thereafter, while supporters, including Obama, were defensive and discombobulated.
Nor was it particularly surprising that Washington’s politics-centric press devoted countless inches and bytes to speculation about the political impact of the online problems: Would control of the Senate flip to Republicans in next year’s 2014 elections? Is this a stain on the Obama “legacy” forever?
Political pundits’ predictions are notoriously unreliable months, weeks and even days before an election, but it was notable when The New Yorker’s liberal Ryan Lizza and Washington Post conservative columnist Charles Krauthammer both wrote (separately) that the troubled marketplace could sink Obamacare and damage and discredit the core principles of American liberalism.
Dudes: It’s a website.
The misbehaving online marketplace is a big, important story, but is all the misreporting unavoidable?
Take the repeated, continuing references to Oct. 1 as the “rollout” or “launch” date of Obamacare.
Nonsense. Obamacare has been “rolling out” for more than three years. The Kaiser Family Foundation lists 89 provisions of the ACA, many of them highly significant, to be implemented between 2010 and 2018. Sixty-five are already in place.
They include the oft-mentioned prohibition on denying insurance or escalating premiums because of pre-existing health conditions (already applies to children under 19; protection extends to adults in 2014); the elimination of lifetime dollar-amount coverage limits for essential health services (annual limits are prohibited starting in 2014); a ban on cancelling policies of people because they got sick; and the option of covering children younger than 26 on their parents’ policies.
But there are scores of other major ACA provisions already in force. Just a few examples:
• Small business tax credits of up to 35 percent of the cost of premiums for employees (up to 50 percent starting in 2014).
• Phased reductions of the gap in prescription drug coverage for seniors, which can cost thousands of dollars per year.
• Requiring insurance companies to apply at least 80 percent of premiums toward health care claims and quality improvement (85 percent under large group coverage), with shortfalls returned to customers as rebates.
• Requiring companies to announce and explain planned rate increases of 10 percent or more. Independent assessments then test the validity of their reasons.
• Requiring companies to use standard summaries of benefits and coverage that allow apples-to-apples comparisons of different policies.
• Reduced government payments to hospitals with excessive rates of hospital-acquired infections or preventable readmissions among Medicare and Medicaid patients.
So notwithstanding the inexcusable initial breakdowns of the online marketplace, a substantial majority of the ACA’s provisions have already taken effect. See for yourself at kff.org/interactive/implementation-timeline/
Reports about HealthCare.gov itself have similarly been marred by basic misinformation. The website launched on July 1, 2010, not last Oct. 1. And — mirroring its smoothly efficient sister government websites Medicare.gov and SSA.gov (Social Security) — HealthCare.gov quickly became a source of straightforward information about the content of the ACA (including the full legislative text), when its provisions take effect, how they affect individuals, businesses and the industry and links to additional information.
Those fact-crammed pages of HealthCare.gov remain fully functional. I had glitch-free, rapid-response experiences over the last couple of weeks, even as the marketplace section was plagued with errors.
It’s true that the federal marketplace and its generally better-functioning state counterparts are important components of the effort to get uninsured Americans to buy health insurance, young Americans especially.
But contrary, again, to frequently referenced stereotypes, the most substantive surveys I’ve seen indicate that young adults don’t reject the idea of health insurance and don’t think they’re invincible. When they don’t buy insurance, it’s mostly because they can’t afford it.
There’s no question that online marketplaces need to work well to make it easier for uninsured people to buy insurance and easier to afford with premium subsidies the law provides for people with low and modest incomes. That describes millions of young people.
But the Affordable Care Act didn’t become law because America hungered for another online shopping experience. It became law because we recognized the insanity of a broken system that sucked 17 percent of the nation’s total economy into a health care sector with restricted access to overpriced care of decidedly uneven quality.
It became law because of the disgrace –- the shande –- of 48 million family members, friends, neighbors and co-workers left at increased risk of death and financial decimation because they lack health insurance in the United States of America.
It became law because we honored immigrants who embarked on a dangerous journey in 1620 with hopes of a better life and who vowed to create a community of people who cared for each other with strength and godliness in the face of adversity.
It became law because we realized that decent health care is a prerequisite to exercising the unalienable rights of Life, Liberty and the pursuit of Happiness with which we are endowed by our Creator and which we enshrined in our Declaration of Independence 237 years ago.
And it became law — after more than 100 years of failed attempts and misguided prideful obstructionism — because we finally understood that it was the American thing to do.