Sommersblog

The End of the Affordable Care Act?

Ben Sommers, M.D., Ph.D. is coming to the City Club to talk about Medicaid, health reform, and the repeal of the Affordable Care Act (ACA).  He has done useful research on all sorts of aspects of insurance for poorer people in the United States. Examples include not only the effects of Medicaid expansions under the ACA on the beneficiaries of that coverage, but issues such as whether expanding coverage discouraged people from working (so they could keep coverage; the answer is "no"); whether states that expanded coverage induced migration from states that did not (also "no"); the extent and effects of "churning" among insurance plans (not good but not as bad as it might be); and how the insurance cancellations supposedly "because of the ACA" at the end of 2013 compared to rates of cancellations before the ACA (there were lots of cancellations before, and people also lost coverage for reasons like no longer being able to afford it, which would not happen as much with the subsidized ACA coverage).

In short, Dr. Sommers is an expert; he knows of what he speaks; and attendees at his talk can learn a great deal.  Alas, how the ACA and insurance in the United States actually work are of no interest to the people in Congress and the Trump administration – most especially the President – who talk about "the failed Obamacare disaster."

Some supporters of the ACA exaggerate its merits: I do not believe for a minute that it is a significant factor in the slowing of health insurance cost increases since the Great Recession as opposed to before it. The coverage through the exchanges is not close to as good as what people receive through large employers because the deductibles are excessive and the networks too narrow, and the law has done little to halt the slow erosion of coverage in those large employer plans, with those plans also requiring higher out-of-pocket payments.  

But the conventional Republican claims about the horrors of the ACA are just nonsense. The Republican platform proclaimed that the law caused deductibles to rise much more quickly than wages; that it "imposed a Euro-style bureaucracy" on medical care; and forced drug manufacturers to raise prices "for everyone else" because of its efforts to limit Medicare drug spending. In fact, deductibles have been rising more quickly than wages for years; the law created no new interference with medical care by "federal bureaucrats"; and if they really believed their claim about drug costs, Republicans must want the federal government to write a blank check to the drug companies for Medicare spending – or not cover drugs under Medicare at all. Perhaps they should have a talk with themselves about why they pushed through the 2003 Medicare drug coverage expansion.

The Republican alternatives to the ACA, such as those proposed in December by Representative and presumably future HHS Secretary Tom Price and on January 4 by the House Republican Study Committee, would make decent insurance far less affordable for ACA beneficiaries. Coverage would need to have even higher deductibles and people in the lower half of the income distribution would get less help to pay premiums. The Study Committee proposal would cut taxes for richer people and then provide extra tax breaks through the way it claims to help people buy insurance. When the Kaiser Family Foundation conducted focus groups with working class Trump voters about the ACA and its reform, some of them described the Republican ideas as "not insurance at all."

When City Club members and guests listen to and question Dr. Sommers, they might learn some of the reasons for these judgments. But I hope they recognize that they also will be hearing information the leaders of our new government don't want to hear, don't want to believe, and ultimately don't care to know much about.

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