It is hard to make headlines with data, when the sensational sells more easily. With this week’s decision by the US Supreme Court to permit the health care subsidies to continue in the 34 states where the federal exchange is used for the Affordable Care Act, the onus is now on the ACA to continue to work. Per several sources, this imperfect and complex law is working pretty well. These sources include – the Congressional Budget Office, Kaiser Family Foundation, The Commonwealth Fund, RAND Corporation and the Economic Policy Institute. Even Credit Suisse and Charles Schwab improved their outlook on US Treasury Bonds due in part to lower healthcare projections resulting from the ACA.
So, it should not be repealed, but could use some improvements. One key improvement would be for the remaining 20 some odd states who have not expanded Medicaid to do so. In these states, the expansion would not only help those in need, per a George Washington University study, it would help rural hospitals, the state’s economy and add jobs. Attached is an article on the impact in my home state of North Carolina.
Yet, what the ACA could use most is some honest discussion rather than political posturing. While working pretty well, the law needs some improvements beyond the Medicaid expansion. With the exception of the mandate to buy coverage, its component parts are well received. But when the nickname of Obamacare is used, the entire law is viewed less favorably. When the name ACA is used, the entire law favorability improves, but is beneath 50%. Yet, in Kentucky, when the ACA name of KyNect is used, it polls more favorably than its national name or nickname.
Part of these findings relate to the overall complexity of health insurance, in general and due to some real concerns over the law. Part of these findings relate to some who want National Health Care insurance, so the ACA did not go far enough in their eyes. Yet. part of these findings relate to politicians using the name Obamacare as a weapon of mass destruction using labels with negative connotation such as Nazism, Apartheid, and slavery, some of which have been used by Presidential candidates. When a strident, uninformed base of voters hears these labels, they tend to believe the labeler. Yet, where I come from, when people use labels, it usually means their argument is less valid or even poor.
Yet, while cost increases have been dampened somewhat by the ACA per the CBO, with increased risk comes the potential for cost increases in areas where competition is small. The overall dampening effect will be more long term with more folks getting treatment before they become train wrecks. The short-term pressure on costs is evidenced by the headline grabbing double-digit increases in some areas. But, those are the headlines. I would look to what people like the Kaiser Family Foundation notes in the attached, that average expected cost increased expected in eleven cities is 4.4% for 2016.
The ACA is here to stay. We need honest dialogue and not labels to discuss how to make it better. We do not need any more votes to repeal, as we have wasted far too much time with ceremonial votes. We need seriousness of purpose using real data and informed discussion. My advice is if you hear a politician use a demonic label on anything, ask them some questions about why they feel that way. You may find that they do not have any sound information to back up those claims.