Wendell Potter
Although there is no shortage of critics of the Affordable Care Act
-- on the far left as well as the right -- it's hard to dispute that the
law has benefited millions of Americans. And not just those who have
become newly insured over the past year.
President Barack Obama
cited some of the impressive statistics last Thursday, the day after the
one-year anniversary of the turbulent debut of the Obamacare-created
online health insurance exchanges.
"In just the last year, we've
reduced the share of uninsured Americans by 26 percent," he said. "That
means one in four uninsured Americans -- about 10 million people -- have
gained the financial security of health insurance in less than one
year."
Approximately 8 million people were finally able to sign up for coverage on the exchanges after the many technical problems
were fixed. Many others were able to enroll in health plans on private
exchanges or by working directly with an insurance company or agent. As a
consequence, the rate of uninsured Americans dropped from 21 percent in
September 2013 to 16.3 percent this past April.
Even though open
enrollment for the Obamacare exchanges ended in April, people have still
been joining the ranks of the insured since then. In fact, the
Congressional Budget Office estimates that the number of newly insured
Americans will grow to 12 million by the end of this year.
A significant percentage of those folks were not able to find affordable coverage in the past,
and many were not able to buy health insurance at any price because of
insurance industry business practices that were outlawed by the ACA.
Before Obamacare, insurance companies were able to declare you
"uninsurable" if you had a preexisting condition, even conditions you
might have been born with.
During the months that health care
reform was being debated in Washington, I met many young people who told
me they had not been able to buy an insurance policy because of
congenital heart defects and other conditions they had had since birth.
Now they can.
That
provision and other parts of Obamacare that force insurance companies
to be more consumer-friendly benefit all of us, but those sections of
the law are rarely mentioned these days, probably because many of them
went into effect long before the exchanges were up and running. Here's a
partial list:
Insurers can no longer "rescind" our policies when we get sick just to avoid paying our medical expenses;
They must allow our children to stay on our policies until they turn 26 if they can't find jobs that offer coverage;
They can't devote more than 20 percent of our premium dollars to overhead and profits;
They can no longer charge women more than men; and
They can't charge older folks more than three times as much as they charge young people for the exact same policy.
The
law also benefits seniors on Medicare by closing the donut hole in the
prescription drug benefit and by covering preventive care, including
screenings, and it is saving the Medicare program billions of dollars by
gradually reducing the extra amounts the government has been paying
private insurers to participate in the Medicare Advantage program.
All
that said, the law falls short in many ways. While it is reducing the
rate of uninsured Americans, it doesn't get us anywhere close enough to
the universal coverage that residents of other developed countries
enjoy. While the ACA will cut the number of uninsured by half in the
coming years, the CBO estimates that 31 million of us will still be
uninsured in 2024.
Many of the newly insured are also finding that
their choices of health care providers is severely limited in some of
the health plans being offered on the exchanges. "Narrow networks" are
not new -- they were common in the managed care plans of the 1990s --
but insurers gradually began to broaden their networks after widespread
complaints. Now they're making a comeback.
The ACA also allows
insurers to sell plans with very high deductibles. They can appear at
first glance to be good deals because their premiums generally are lower
than plans with more modest deductibles. But many people who enroll in
high-deductible plans find out after they get sick or injured that they
can't afford to pay their share of their medical bills. Although the ACA
does put a limit on out-of-pocket expenses, it still will not prevent
many insured families from filing for bankruptcy after a serious
illness.
And while the law apparently is helping to keep medical
costs in check, it doesn't go far enough. We still spend more per capita
on health care than any other country. In that sense, I agree with my
former colleagues in the insurance industry: The law doesn't do enough
to address the "real cost drivers" of medical inflation. That will
require taking on the hospital companies, physician organizations and
drug makers in ways the White House and members of both parties in
Congress were not willing to do in 2009 because of the political clout
they have in Washington. Consequently, much more reform will have to be
undertaken in years to come.
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