The Affordable Care Act continues to build its resume, even though there are some who try to ignore this growing success for political reasons. That is unfortunate as many who have not considered the ACA are shortchanging themselves due to available subsidies, which are favored by the majority of Americans per the Kaiser Family Foundation. More on this later.
It troubles me when I see people who are part of fundraising events to raise $150,000 or more to pay for medical bills for an injured or sick child because they lacked healthcare insurance. If these folks had signed up for the ACA, the only money they would need is for the out-of-pocket limit which usually run in the $5,000 to $20,000 range depending on the plan selected. As I have noted before, the number one reason for personal bankruptcy in the US is no or poor healthcare insurance. Yet, it is not too late, as they can still sign up for care since coverage is guaranteed, which previous policies did not offer.
With three weeks to go in the ACA’s current exchange enrollment season, exchange enrollment has hit 9.6 million passing the President’s expectations. The exchange enrollment will likely push toward the Congressional Budget Office (CBO) target of 12 million by the middle of next month. It should be noted this does not include enrollment under Medicaid in the majority of states who did expand Medicaid, which will only improve with more states considering such expansion.
Further, the non-partisan CBO has for the second time reduced its projections of future medical costs as a result of dampening costs due in part to the Affordable Care Act. As an actuary and former benefits consultant and manager, having more folks covered will help further dampen costs as they seek treatment and get medications before they become eventual train wrecks. Plus, by seeing doctors and nurses in advance, the long term costs are further dampened as they are being served in the more cost-effective place and not in an Emergency Room in a crisis.
But, back to the Kaiser Family Foundation survey from January. Many may not realize that some strident opponents have brought a lawsuit that questions the ability of the federally run exchanges to offer the subsidy. The federal exchanges had stepped up to cover 37 states, when some states asked them to do so. The US Supreme Court will rule on this later in the year. I do not anticipate that they would rule unfavorably, but stranger things have happened. If they did about 10 million Americans would be screwed, sorry for the use of the most appropriate term. Yet, per Kaiser, what would Americans want in that case:
- 64 percent say Congress should pass a law making subsidies available in all states;
- 40 percent of Republicans favor such a law, with a solid majority of Democrats and Independents supporting such legislation;
- 59 percent of residents in the healthcare.gov states say they would want their state to act to operate its own exchange;
- By party declaration, 61 percent of Democrats, 63 percent of Independents and 51 percent of Republicans favor a state exchange in those now served by the federal exchange.
Given the fact there is a cost to running an exchange, many of the states asked the federal government to take the lead. In fact, a significant number of state attorney generals have written to the US Supreme Court to not rule against the subsidy.
With all of its complexity and communication challenges, which is partly due to Americans not understanding healthcare insurance, in general, the ACA is building a resume of success. This Congress should heed Americans wishes to improve it where possible, but accept that it is showing success. And, the remaining state legislatures should expand Medicaid as it would help many residents in need, help their economy even further, and keep rural hospitals afloat to serve.