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.