A few true statements about the ACA

In an effort to continue a push toward repeal of the Affordable Care Act, many statements have been made that are not truthful. But, this is not a surprise, as opposition to this imperfect law has used untruthful statements to show its lack of veracity. I should emphasize the following are opinions of a former benefits actuary, former benefits manager and a retired benefits consultant.

  • The ACA is not in a death spiral as stated by Speaker Paul Ryan, Senate Leader Mitch McConnell and President-elect Donald Trump. Who says so? The American Academy of Actuaries in a letter to Congress.
  • The ACA is imperfect and complex, but so is our healthcare system. In spite of this, the ACA is working pretty good, but could stand some improvements.
  • One key improvement would be to fully fund the risk corridors to help insurers with adverse selection. These were cut back by Congress to help strangle it. My former Republican friends are being very silent on this tactic, but it was done with intent to cause premiums to go up.
  • Another key improvement would be for the remaining 19 states to expand Medicaid, which would improve the states’ economies, rural hospitals and people in need. Who says so? The Commonwealth Fund, Kaiser Health Family Foundation, RAND Corporation, Economic Policy Institute and a George Washington University study. Data shows these states have reduced personal bankruptcies and hospitals have better accounts receivables.
  • A few other improvements would be to add a public option where needed to increase competition and reduce cost. We should also look at the various fees and determine which ones should stay or go. These fees help fund the subsidies.
  • A November poll from Kaiser Health noted 74% of Americans want the ACA to continue with improvements, with 48% of Republicans. It should be noted this survey shows with the exception of the employer and individual mandates, even Republicans like the specific features of the ACA by 63% (guaranteed issue and renewability) to 82% (continuing adult children to age 26) depending on the feature.
  • If the risk corridors are funded, this will help with higher premium increases and bring some insurers back to markets, yet we still have cost pressures – we are an overweight, overmedicated, and aging nation. As for prescriptions, other countries do not allow R&D to be factored into their pricing, so the US bears the brunt with their prescription cost.
  • Repealing the law will have a negative impact on the debt over the next ten years, so say nonpartisan budget reconciliation groups such as the CBO. This should be a factor in the analyses.
  • Then, there are the 20 million plus Americans who have benefitted from the system. If we are unwise with how we make any changes, people’s lives are affected.
  • A key item which is not discussed is the administration of the system. After the terrible exchange roll-out, which I fault the President as this was his baby, the system is working pretty well. Changes have to be administered. We should not lose sight of this, as many politicians do not have a good understanding of the complexities including the three folks mentioned above.

Healthcare is complex. Insurance is complex. So is the ACA. If the ACA is repealed, Republicans now own the problem. Since the ACA is largely based on a Republican idea borrowing features from Romneycare, it will be difficult for them to come up with a new idea, “something terrific,” which meets their objectives. We need a systematic, data centric analyses of what is working and what could be changed

One thing I know for certain – ramming a change through is not prudent, nor good stewardship.

23 thoughts on “A few true statements about the ACA

  1. I’ve never understood why the Republican leaders are SO strongly dead set against the Affordable Care Act. They act like it is the epitome of evil. Is it purely partisanship? What’s the real issue here? Why are so many people so eager to say “Yes, I was part of the project to keep health care from millions of Americans. Yay, me!”

    • Debra, to me this imperfect law with its lightning rod nickname is the epitome of the zero-sum game. I must win and you must lose. The American people are secondary. Rather than 60 repeal votes – why not work along the way to make it better? Fully fund the risk corridors while making other changes. Some Republicans are beginning to realize the gravitas of the problem with repealing it. This is why the three so called leaders are rallying with the death spiral exaggeration. Thanks for your comments, Keith

  2. Dear Keith,

    This is the best analysis of the ACA issues that I have read in recent times and thanks for doing this.

    There is one more republican talking point that is misleading. Surrogates keep saying that the ACA tells subscribers what physicians they can see but they neglect to say, that it is the insurance companies that do this whether via the ACA or through an employer.health insurance policies.

    Ciao, Gronda

    • Gronda, many thanks. That means a lot coming from you. You are correct about the insurance company networks. There is also a lack of understanding by those who say allow folks to hire an insurer from another state.

      What is not factored in is these insurance companies have to “lease” a network in the state, which has doctors and hospitals included with discounts for its members.

      Some of the carriers choose not to be in the ACA as they want to underwrite and screen the prospective members. A huge benefit of the ACA is guaranteed issue and renewability. This drives up cost, but if you have diabetes or heart condition, the ACA must take allow you to be covered.

      Thanks again, Keith

  3. They have harped so relentlessly on repealing this thing, that I cannot even understand how they got here without a viable plan. It’s wanton malfeasance in my opinion. How can they even stand to look at themselves in a mirror is beyond me.

    It’s my opinion that they will repeal with a delay and then they be unable to come up with viable solution and thereby create a nightmare.

    I would not be surprised if I have no insurance in 2018 or 2019.

    • The dilemma is the ACA is largely the GOP plan with modifications. Some of Romneycare elements can be traced to Bob Dole’s plan. Trump said again how disastrous the ACA is using the term imploding, but it is not, per the American Academy of Actuaries. The best thing the GOP could do is work with Dems to fix it. Especially since they have done their best to hobble it.

  4. So much of what has gone wrong with the ACA can be attributed to the poison pills thrown at it by the Republicans. And, the parts that people really like and want to keep (which will be very hard for those who oppose the law to get rid of) require some sort of mandate. With DT pushing for a quick repeal and replace, it will be interesting to see what they come up with that is “better and less expensive.” After having 6 or 7 years to develop alternatives, I’m sure it’s gonna be GREAT!

    • Janis, what do the advertisers say about any new and improved product? The new plan will offer more benefits and be cheaper. Think about that statement. On its face, it is not likely, which is yet one more Trump misrepresentation. Keith

  5. Note to Readers: My former party is not desirous of looking at data. They just want to shut the ACA down. A first measure of repeal passed through the Senate budget process, which is not the best place to do thoughtful measures. They have made up their minds and this law is a disaster says the President-elect and in a death spiral says Ryan and McConnell. All three are wrong, but that does not matter.

    What we will likely end up with his a system with some protections, but no obligations to buy, with some tax credits for some. Yet, as I said earlier, the administration of the ACA is in place, why don’t you just modify the ACA to fit in your needs? Why? Because they have misrepresented the law and its woes, without mentioning the positives, so the have convinced too many Americans to believe yet another lie.

    I did not say this above, but have said it before. If repeal is done poorly, it will contribute to a recession. More money is being in spent on healthcare by a plan, releasing more to spend on other things. If healthcare spending retrenches, then there will be an echo effect.

      • True. I don’t know that number, or if they were included in that original 20+ million I hear quoted a lot.

        The number that actually gets to me is the estimate that some 27-36 thousand people a year will die unnecessarily when the ACA is repealed.

      • Initially that number was around 3 million. What concerns me is caring for people is secondary to the current process underway.

      • That is what I remember as the number added due to the age 26 change which occurred prior to the exchanges and Medicaid expansion.

  6. Note to Readers: I was recalling the story two summers ago about the North Carolina Republican Mayor of a small town. NC is one of the states that did not expand Medicaid under the ACA. The Mayor was trying to save his local hospital and petitioned the NC General Assembly to expand Medicaid. When they would not heed his request, he walked to Washington, DC to see if he could get some footing there. The GOP legislators criticized the “lamestream media” out of impulsive reaction for publicizing this story. But, the point is per the groups I cited above, expanding Medicaid helps people in need, state economies and rural hospitals.

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