Diverging Views On Health Care Reform

Now that the King v. Burwell case is over I was curious whether both sides would find common ground on meaningful health care reforms. I was surprised to hear that Kathleen Sebelius says the law is working as intended and we should use this new opportunity to build on its early success. She is not alone. Sara Rosenbaum provided this list of health care reforms in the article, Post-King: Moving Forward In A New Normal.

  1. Expanding Medicaid To Cover The Poorest People
  2. Making the ACA’s Private Insurance Provisions Work Better For Children, Low- And Moderate-Income Families, And People With Disabilities
  3. Making The ACA A More Potent Force For Cost Containment And Quality Improvement Building Primary Health Care Access For Medically Underserved
  4. Communities And Populations And Addressing The Underlying Social Conditions Of Health

John Goodman thinks there are some serious problems with the Affordable Care Act and lists these problems in the article,

Six Problems With The ACA That Aren’t Going Away.

  1. An Impossible Mandate
  2. Unworkable Subsidies
  3. Perverse Incentives For Insurers
  4. Other Perverse Incentives For Buyers
  5. Lack Of Access To Care
  6. Impossible Burden For The Elderly And The Disabled

It is interesting that neither side talks about the cost of health care for the middle class and the fact that the ACA has made health insurance unaffordable for unsubsidized people. In an ironic twist of fate the Affordable Care Act very existence depends on convincing these healthy, unsubsidized, middle class people to purchase health insurance from the exchange. When you look at the report from Avalere Health, Exchanges Struggle to Enroll Consumers as Income Increases, it is easy to anticipate a death spiral in the exchanges if only 2% of the eligible people with income over 400% over the federal poverty limit are enrolled in the exchanges. The problem for ACA supporters is no longer politics but math. As I wrote in a previous post the cost of health insurance from the exchange versus my grandfathered plan is a very strong incentive for me to keep my existing health insurance. Perversely if my health insurance is not grandfathered for another year, my second best choice is to go without health insurance since I am exempt from the individual mandate because “health insurance from the exchange is not affordable”. Everything is in place for the exchanges to fail and the ACA supporters say the law is working as intended. I guess we have to break it before we can fix it.