Alabamians on the federal Affordable Care Act, known as “Obamacare,” are getting rocked by premium increases this year.
Numerous reports last year told Obamacare recipients in Alabama to expect their insurance premiums from Blue Cross Blue Shield to increase 36 percent on average. That sharp upturn in cost follows a 28 percent hike from 2015 headed into 2016.
Throughout the 2016 campaign, then-candidate Donald Trump promised to repeal President Barack Obama’s signature health care law. We’re roughly 27 days into Trump’s presidency, and the odds of that happening in the near term are decreasing day by day.
It is not entirely Trump’s fault. Republican lawmakers have become skittish about completely scrapping Obamacare. The fear, of course, is that repeal will cause some people to lose their coverage, opening the door to the usual Democratic fear-mongering we have seen during past Republican administrations.
But a fear of demagoguery does not change the fact that Obamacare is an unpopular law fraught with problems. Something will need to be done about the massive health care law sooner rather than later.
Frankly, the idea that you could maintain the pre-2010 business model for health insurance companies and cover everybody at the same was destined for failure. For starters, the dirty little secret is that Obamacare is a humongous wealth redistribution program that greatly benefits insurance providers.
For it to work, the law requires healthy people to pay for a health insurance product they do not necessarily need and might not even use (hence the individual health insurance mandate). The health insurance companies can take proceeds from an overpriced product and put them toward subsidizing the cost of health care for the unhealthy. And naturally, what could be better than a law requiring people to buy your product!?
What seems immoral about the scheme is that the healthy tend to be the younger, less wealthy generations and the unhealthy tend to be older, wealthier generations.
There are other questionable aspects of these programs, including requiring, by law, a man to buy a personal plan that includes coverage for breastfeeding, prenatal care and birth control, or a woman to buy a plan that covers prostate health or erectile dysfunction medication.
According to a survey from pro-Obamacare research foundation The Commonwealth Fund, the Affordable Care Act has put a dent in the number of uninsured. From 2010 to 2014, the adult uninsured rate fell from 20 percent to 15 percent, or 9.5 million fewer uninsured.
But this has come at a very a high cost and represents a very small portion of America’s 318 million population. In 2012, the Congressional Budget Office estimated the cost of Obamacare to be $1.76 trillion over 10 years. That is triple the CBO’s estimate in 2010, when Obama signed the bill into law.
And the price tag just continues to escalate.
So what now? Republicans have had six years to come up with a game plan on this. When they won the House in 2010, they made a lot of symbolic efforts to repeal the ACA. When they won the Senate in 2014, Republicans told voters they needed the White House for total repeal.
Now that they have it, some Republicans are signaling that they want to delay action on Obamacare.
There are a few things they could do in the short term. What happened to eliminating the stateline boundaries for health insurance? Allowing these state-by-state monopolies — like Blue Cross Blue Shield of Alabama, which covers 90 percent of the state’s population — results in limited competition and therefore no incentive to lower costs.
If you want evidence of crony capitalism in our health care system, allowing for this system to continue to exist is it. The statewide monopolies are something the ACA should have eliminated.
What about all the really sick people, those with pre-existing conditions and in need of medical care? Without making health insurance mandatory for all, health insurance companies would be unable to offer a product to those with pre-existing conditions. What about them?
One idea is to create a high-risk pool for those individuals. Sure, the cost would be exorbitant, but ideally that is where you would want extra funding reserves. Tax dollars would be better used put toward those with high-risk medical conditions than to subsidies for the young and healthy.
Let those who are young and healthy pay for a plan based on their needs, which may or may not include coverage for breastfeeding, prenatal care, birth control, prostate health or erectile dysfunction medication.
There is no question about it: Trump inherited a bad hand on Obamacare. The hand became even tougher to play with all the promises he made on the campaign trail. But one thing Trump has going in his favor is Obamacare is very unpopular.
The media are not going to make repeal — or, actually, any part of his agenda — easy on him or congressional Republicans. News outlets will scour the countryside for any sob story resulting from whatever changes are made to Obamacare.
If some plan is implemented and the bulk of Americans feel a noticeable change for the better in their health care costs, it will not matter what Democrats or the media do. Chances are those who are benefiting from Obamacare likely did not vote Republican in the 2016 election anyway.
On the other hand, not doing anything to appease a minority would be politically disastrous.
Repealing and replacing Obamacare was one of the key parts of Trump’s campaign. The people who did vote for Trump won’t come out to vote again if this promise isn’t fulfilled in the near term, and the whole “Make America Great Again” populist movement might be for naught.