Reading letters to the editors in various newspapers on the Affordable Care Act (ACA), while a few concerns have merit, there is much undue criticism. The ACA is working pretty well in expanding coverage to uninsureds and is actually dampening costs per the Congressional Budget Office and PricewaterhouseCoopers. When its components are surveyed (guaranteed issue and renewability, preventive services, elimination of lifetime limits, capping profit margins baked into premiums), it actually polls favorably.
As noted before, the components poll better than the whole ACA, which in turn polls better when the name Obamacare is used. Yet, more people like the whole ACA than do not, which is a recent trend. However, even the recent polling is sloppy, as a solid 15% of people want the ACA to do more and be replaced by National Healthcare which is working well in other countries. So, these detractors are different from detractors who oppose it for political or free market reasons. While I would support elements of National Healthcare here in the US, that is not likely to happen, so the ACA is a good step forward down that path.
Regarding the subsidies, what many don’t realize is insured buyers were already subsidizing costs in hospital price increases to cover the uninsureds. Absent a move to National Healthcare, this was a reasonable approach to gain access to many in need with affordable prices. The argument to do away with the subsidies to have a free market care system, would fail as many people could not afford coverage and we would be back in the same boat as before. What is also forgotten is the Chief Financial Officers of companies were asking for more consistent healthcare costs as rising costs were harming their profit/ loss statements. The ACA has actually helped accomplish a dampening of cost increases per the above two sources.
As a retired benefits professional and actuary, I am encouraged by the progress made by the ACA. Getting people access to coverage will help them get treatment in advance of worsening conditions. Its success is also in spite of twenty some odd states who have not expanded Medicaid. The states who did so are seeing better results in cost dampening and hospitals are more secure in funding. It would be nice to see the impact of ACA when fully implemented with all states expanding Medicaid.
I personally do not anticipate the Supreme Court to do away with the subsides in the national exchanges for the states who punted. I have always seen the court case to challenge the subsidies as narrow-minded and not looking at the context of what the law is trying to do. Also, running the national exchange for the states who asked was helpful to those states, so to now belittle those states and screw millions of people over, is cold-hearted. But, stranger things have happened. If it does happen, it is an easy fix, but hopefully it will not come to that given unnecessary politics.
What we don’t need is people who are against this law for political reasons to continue to find different ways to hammer it. Which is a shame as it is working pretty well and is ironic as it is based on a largely Republican idea. Let’s improve where needed, but do not do away with it.