ACA: Not ideal, but positives outweigh negatives in short term (Part 1)

Jack Bernard, a retired SVP with a large national healthcare firm, has worked extensively with hospitals across the nation regarding cost containment and insurance. He was also the first Director of Health Planning for the state of Georgia.

After my recent column on Medicare for All, I have been asked by readers to clarify my position on Obamacare, the ACA. It is a complex task. The ACA is misunderstood by both politicians and the public.
For example, take State Senator Mike Williams of Cummings, who was defeated in the recent GOP Gubernatorial race. He was on CNN on 6-24-17 speaking about “repeal and replace’’ Obamacare (ACA) with a free market solution. He had no specifics at all, but just thought that free competition has helped millions to have a better life in general (it has). He also had no knowledge of the non-partisan Congressional Budget Office score for the ACA.
At the same time, he indicated that he wanted to put pressure on the drug companies and insurance companies that were only “pursuing profits.” He also stated his premiums had escalated and that he owed “tens of thousands of dollars of medical bills” due to a major accident that his son was involved in resulting in a dozen surgeries. He never mentioned Medicaid expansion at all.
From what I could see, he really cares about the taxpayer but is just frustrated, looking for a simple solution, “repeal and replace,” which he believes is better than Obamacare due to ACA premium escalation. It was also obvious that he had very little specific knowledge of healthcare financing and delivery, or of the history of the ACA.
How did the ACA get enacted in 2009? From a political and policy standpoint, the ACA model was an odd choice for the Democrats since that program originally came out of a policy paper by the far-right Heritage Foundation, currently run by Jim DeMint, a Tea Party darling.
The Democrats controlling Congress made a conscious choice to mimic Romneycare, already in place in Massachusetts.
Here’s why:
A. Because conservative Democrats did not want to alienate their deep pocket backers (i.e. big Rx and insurance companies).  By using a private versus public insurance model for the exchanges, the ACA would increase their profits. Therefore, Obama thought that provider, insurance, and pharmaceutical company money would be essential for an ad campaign designed to support the ACA, rather than oppose reform as they did with Hillarycare in the 1990s. He was right.
B. Obama naively (and incorrectly) believed that the GOP would support the ACA, the Democrat’s version of Romneycare, a Republican program. Romneycare simply built on the private insurance model rather than expanding more efficient governmental insurance (Medicare) to cover the majority of currently uninsured Americans.
On the public side, the ACA did include expanded Medicaid in each state, paid for primarily by the Feds (100 percent for three years, eventually falling to 90 percent). The “stick” was that if each state did not expand, it would lose all pre-existing Medicaid dollars. However, thanks to Chief Justice Roberts, this stick was removed by a highly political SCOTUS decision.
Thus, expansion has been made voluntary with each state deciding whether or not to take the money. Many red states, especially in the South, are refusing to take the federal funds, coming up with weak budgetary arguments rather than telling the truth: theirs was a political decision, including Governor Deal and the Georgia legislature.
Health insurance for all Georgians is just not a GOP priority here. Further, if our GOP controlled Congress wanted to do so, it could always waive the 10 percent that states now contribute, eliminating this objection.
In my opinion, the Medicaid portion of the ACA is its best feature. Millions of working-poor people making between 100 percent and 133 percent of the poverty level will get coverage if these red states eventually expand Medicaid, which they may if given programmatic waivers by the Trump administration.
As for the other part of the ACA, 12 million people have signed up for insurance via the “exchanges.” Some were without coverage and some have purchased more comprehensive policies than they had before (more about this in Part 2).
Like Williams, Trump, and my Republican brethren, I do not believe that the Affordable Care Act (ACA, Obamacare) is the optimal program to get our citizens insured, although it has brought the uninsured rate down from a 2010 high of 18 percent. Having 9 percent of Americans uninsured, even after the ACA has been fully implemented, should still qualify as a crisis.
Unlike them, my solution is not installing unproven radical private market theories. Speaker Ryan and former Sec. Price advocated for policies that would almost double the number of uninsured, as shown by the GOP’s various versions of Trumpcare (per CBO projections). Part 2 will cover why we need Obamacare short term (as well as the long-term solution for cost effective universal health insurance).




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