It's not my intent to trash Obamacare (a.k.a., The Affordable Care Act or ACA). Provisions already in effect really have made health care more affordable and accessible for many Americans. But other families and individuals are still out of the loop. While insurance carriers can no longer impose lifetime caps on their policy-holders, or reject them for pre-existing conditions, there's precious little control over the premiums that carriers can impose, at least for now.
The state-coordinated insurance exchanges scheduled to kick in next year, with mandated coverage and available subsidies may help a lot. But judging from what I've understood, the various plans will probably be more expensive and cumbersome to administer than the single-payer option. With its near-total reliance on private-sector health insurance providers, the system is still very much profit-driven. Conversely, universal health care would be tidier and less costly to maintain. It works reasonably well across the pond. (In Germany, the carriers are non-governmental, but also non-profit).
Another potential obstacle: the coverage mandate for businesses with more than 50 employees. Having just been postponed for a year, it's now scheduled to take effect in 2015. I've read mixed reviews about this measure and honestly don't know what the impact might be. (The vast majority of domestic businesses don't come close to approaching that 50-employee threshold, yet a few growing enterprises could conceivably roll over that hump).
In the meantime, many congressional Republicans are still obsessed with their compulsion to repeal the ACA in its entirety. It's what now, their 41st attempt? The Republicans have been aided in their effort to hobble Obamacare by an organization called the National Federation of Independent Businesses (NFIB). (Despite the name, the NFIB is funded largely by four very generous donors, who account for well over three million dollars of their war chest of several million).
Last year, the NFIB was the lead plaintiff involved with a Supreme Court appeal to trash the ACA: National Federation of Independent Businesses vs. Sebelius. This effort didn't succeed; a 5-4 majority, including Chief Justice John Roberts, upheld the individual mandate. However, Justice Roberts switched his position in regard to Medicaid expansion.
The individual mandate remains intact, but individual states now have the right to opt out of expanded Medicaid coverage for their poorest residents. (These are folks whose income is too low to qualify for the exchanges. Without Medicaid expansion, they'd remain unprotected). It appears as if over 20 states have rejected it outright, while another few are still deliberating. This, despite the fact that the new Medicaid recipients would be fully funded by the federal government for the first two years. Beyond that time, the states are expected to kick in small, but increasing increments until they're capped at the rate of 10% in 2022.
Because many state budgets are in the red, fiscal hardship could be cited as an excuse for some states to deny their residents desperately needed Medicaid coverage. Changing the terms of such coverage to full federal funding for the foreseeable future might be worth considering.
Thereafter, any state legislatures still refusing to accept Medicaid expansion would be doing so for buck-naked ideological reasons. The only rights really being compromised would be those of the folks denied decent health care.
Just a thought.
I agree with your analysis. Some states may have both ideological and budget reasons to throw the poor under the bus, so I'm not surprised.
ReplyDeleteI recently recurred to some premiums
shown on the web, and was shocked at the ~$400/month and more rates. Yow! I couldn't eat or pay my electric bill if I was stupid enough to get such insurance.
Employers with 50+ workers would probably go under if they net modest profit margins. The obvious answer is to cap premium
amounts to more reasonable levels.
We'll see....