When President Obama first announced his plans for a health care overhaul, I was skeptical and quite vocally so. The main reason for my anger was that there were logical certainties given the nature of the legislation, and the President was elected for a second term based on campaign claims in direct opposition to these certainties. In fact, the “If you like your health care, you can keep it” claim was named PolitiFact’s “Lie of the Year.”
I like to consider myself open minded, so after my initial outrage at the Obama campaign’s deception, I decided to give it a shot in an honest, intellectual way. I know (or at least feel) that the President had no malicious intent for the country — helping the less fortunate is his goal.
I think we shouldn’t judge the Affordable Care Act (ACA) by its intent, but by its reality. Does it really do what it was intended to do? If so, are the many publicized trade-offs (you can’t necessarily keep your insurance plan, doctors, etc.) worth it?
I’ve heard lots of anecdotal evidence of the ACA hurting more than it helps, but I wanted to see how it would directly affect me. My wife and I currently have health insurance through her job. The money for our insurance is paid for from her paycheck at a rate of $195 per month. This plan has a $2,500 deductible. After entering our information on Healthcare.gov, I looked at and compared the seven other available options. In order for us to keep the same level of coverage, we would have a significantly lower $200 deductible, but our monthly cost would be $387 a month. The plan actually costs $554 a month, but our income level qualifies us for a $167 tax credit.
It’s no stretch to assume that our standard of living would be severely decreased if we had to take on an extra $200 a month. In short, we’d be getting nearly identical coverage and paying enough extra per month to purchase a new car (of course, without the benefit of having the car we’re paying for). There are a few reasons I’m seeing a higher deductible.
One is my age. Another of my disagreements with the ACA is that the young and healthy have to subsidize the old and sick. Another is that fewer of the big insurance companies decided to participate than was originally estimated. That is, there is actually more rate competition outside the Health Care Exchange than in it.
The Exchange, or Marketplace, is meant to act as a middle man between the insurance companies and the consumer. They do the dirty work, ensuring that insurers comply with consumer protection laws, help with cost-effectiveness of available plans, et cetera. They even have a say in which plans can be offered by insurers.
As for the setup and maintenance of the exchanges, states were given three options: a state-run exchange, leaving exchange creation to the federal government, or a hybrid of the two. With the bookending options, the state directly carried at least some of the tax burden. Failure to set up an exchange spread the monetary responsibility throughout the country.
During the summer of 2011, Alabama Gov. Robert Bentley created a commission to research and decide which exchange set-up option was best for Alabamians. The commission actually supported the creation of the Alabama Health Insurance Marketplace. In direct opposition to his own committee’s findings, Gov. Bentley had Alabama join 24 other states in having the federal government handle their exchange.
When taken at face value, this looks like nothing more than a Republican governor’s attempt to prove to his constituents just how fed up he is with federal interference. My interpretation of the governor’s actions shows them to possess a little more finesse.
Bentley, as part of his campaign, actually sought to create a state health exchange. At its onset, this move was not related to the ACA. Most Republicans believe that state governments are far more capable of attending to the needs of their citizens than is the federal government. I think the governor’s ideology follows suit, but as a doctor, Bentley was able to admit something that other Republicans weren’t: the American health insurance system was not helping the less fortunate and needed a makeover.
Take a look at how insurers handle healthcare for corporations. They are able to provide lower prices because companies have a smaller subset of customers about whom they can gather the critical information needed for proper risk evaluation. It’s this evaluation of risk that sets prices. If the group is at greater risk for heart failure, the group pays more for the addition of heart-health related coverage. If you apply this thinking to the state level, you would be able to maintain lower costs while increasing insurance coverage.
It sounds remarkably like the Affordable Care Act, but there’s a key difference. The federal government has shown time and time again that it is incapable of providing any service at a reasonable cost. The contractors who built the infamous Healthcare.gov website have $677 million obligated to them by the Department of Health and Human Services. I would happily get a Masters in web design and make the website myself for $2.5 million.
Gov. Bentley refused to establish the state exchange, not out of spite, but to stand on principle. There is no benefit to making Alabama taxpayers pay a $50 million bill for a federally controlled program that promises to be just as inefficient and inept as previous government programs. Since the feds would ultimately control the exchange anyway, why make the people of Alabama solely responsible for the exchange in addition to their foreseen increases in deductibles and premiums?