For a Reasonable ACA Debate   Leave a comment

Back in January, Chuck Schumer kicked off the fight to save Obamacare with the slick slogan “Make America Sick Again.” Basically, the idea is to frame the dialogue by pushing hte narrative that Republicans want to repeal Obamacare and deprive millions of people of health insurance without a replacement plan. If Republicans can’t disprove that dark fantasy, they will deserve a midterm drubbing.

Image result for image of obamacare failureLet’s be clear – Obamacare is horrible. The unAffordable Care Act has increased health-care costs for many people. You don’t get to keep your doctor or your insurance plan. That’s important to say because it is the overwhelming reality for many Americans.

But recognize that Obamacare’s misguided supporters can trot out individuals who have benefited from the provisions of the Affordable Care Act and these two points against Obamacare does nothing to counter the now-growing narrative that 20 million Americans will lose their insurance if Congress repeals Obamacare.

I totally hate Obamacare, especially since Brad has spent the last three months just trying to get in to see a doctor for a shoulder injury and still hasn’t received any actual treatment, though he now has a diagnosis – quadralateral space syndrom. A muscle was damaged (trying to keep up with the teenager at bouldering) and the resulting scar tissue is pressing on a nerve. By the way, without an MRI machine or any real training in medical care beyond a few basic first aid classes, I guessed this problem. I sent him to the doctor to FIX the problem, but so far, crickets. Except we are now paying medical bills. Was the point of Obamacare to make health care less affordable? It’s working.

Back to the topic. Opponents of Obamacare must acknowledge, frankly and sincerely, that the Affordable Care Act has helped some Americans and assure the pubic that the replacement plan will also protect the sick and vulnerable. Take the anxiety away. Then stress that while the law created some winners, it also created many more losers, and that Obamacare supporters are blindly ignoring this reality.

Next, the repeal and replace faction must counter the false impression that the Affordable Care Act created 20 million winners. It’s important to understand that 20 million figure was an estimate from the Obama administration that comes from a government figure rather than actual enrollment data.

Here, proponents of repeal and replace should first remind Americans that the 20 million figure is merely an estimate from the Obama administration. Actual enrollment data, compiled by the Heritage Foundation, tells a different story. About 14 million people gained coverage from the end of 2013 to the end of 2015. Of that 14 million, 11.8 million gained their insurance through Medicaid expansion (otherwise known as welfare) and 2.2 million through private coverage. Other problems with the 20 million figure were outlined by the Heritage Foundation, laid out at length for Forbes. These too should be highlighted.

But adjusting the 20 million figure downward to reflect a more accurate count will still result in a fairly large number of Americans obtaining insurance under the Affordable Care Act. So how to answer that? Explain that health insurance does not equal health care.

Brad and I have good health insurance. My employer is the largest group pool in Alaska. The union I am reluctantly a member of has been fighting being labeled a “cadillac policy.” That doesn’t do Brad any good because despite having medical insurance, he can’t get medical care.

We have to remind the public that while Obamacare helps some individuals, it harms many more. That’s my major argument with Obamacare boosters. They seem incapable of acknowledging this truth. They portray the Affordable Care Act as merely having some minor glitches which, if Republicans only helped, could be addressed. “Just tweak it,” they say.

Nonsense. It’s not a glitch that the unAffordable Care Act created losers. The law was intended to do that. Obamacare sought to cover older and sicker Americans by providing them government subsidies, which makes the taxpayers the losers and ripping off younger and healthier Americans. Because young and healthy Americans stayed away from the exchanges, insurance companies were forced to increase deductibles and co-pays and limit doctor and hospital networks, making the healthy individuals who did buy insurance even bigger losers.

The more indirect losers—such as workers unable to find full-time employment because of the Obamacare mandates, as well as doctors in private practice forced to sell out to hospitals—are more difficult to quantify, but they are just as real.

The Left hammers the need to protect those with preexisting conditions, but then acts as if Obamacare is the only way to do this. The public needs to learn that individuals with preexisting conditions who were unable to obtain insurance before Obamacare were only about 14 percent of the population. Obamacare did not adequately address the issue. About 10 percent of individuals with pre-existing conditions are still uninsured, and Obamacare doesn’t assure medical care for the seriously or chronically ill. There are a lot of people now paying so much for health insurance that they can’t afford actual medical care.

While those with uninsurable preexisting conditions represent just a small portion of our society, a replacement plan must address their needs, but what many Americans don’t know is that the Health Insurance Portability and Accountability Act of 1996 already provides some protection for those with pre-existing conditions who lose their insurance.

While the public thinks of HIPAA as a law protecting the confidentiality of medical records, prior to Obamacare, HIPAA prohibited both group insurance plans and plans obtained in the individual market from excluding coverage of pre-existing conditions, under specific circumstances.

HIPAA’s protections had some gaps, but an Obamacare replacement plan can address those limitations separately, and without upending the entire insurance market, perhaps by providing grants to states to fund high-risk pools. Alaska already had such a pool that offered coverage prior to Obamacare. Like many states that offered these plans, it was discontinued as a result of Obamacare, but the Alaska Legislature is already seeking to reinstate the state-sponsored pool as high-risk insurers flee the market.

Other than adult children with chronic health conditions, the real beneficiaries of Obamacare’s 26-year-old coverage mandate are the parents. I cover both of our adult children because it gives us peace of mind that if something happens to my risk-takers, they will have coverage. But that benefit comes at the cost of higher premiums for all families with children. Require insurance companies to provide one quote covering children up to 26 and one that doesn’t. The true cost will no longer be masked, and parents can decide then if the cost is worth it. And I’ll negotiate with my children as to whether they should reimburse me for this expense as we do with care insurance.

Finally, Congress should add provisions for tax-free contributions to health savings accounts for the payment of medical expenses and for the purchases of medical insurance.

Then stop. Americans don’t want another comprehensive health care overhaul. Let’s give it time to see if the reform works to bring down costs and improve medical care again.

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