Health Care \u2013 Carrots and Sticks<\/p>\n
Tuesday is election day in America.\u00a0 This year\u2019s midterms have become a referendum on the Republican control of government, and on President Trump in particular.\u00a0 One of the great \u201cfailures\u201d of Republicans in the last two years is their inability to \u201cget rid of Obamacare.\u201d\u00a0 After fifty-four attempts to end the Affordable Care Act while Barack Obama was President, once Republicans gained Congressional majorities and the Presidency, they couldn\u2019t get it done.\u00a0 It came down to a single vote, the famous middle of the night \u201cthumbs down\u201d of Republican Senator John McCain.<\/p>\n
The Affordable Care Act was a compromise of proposals among the Congressional Democrats in 2009.\u00a0 Many wanted to create a \u201csingle payer\u201d system \u2013 Medicare for all; but were unable to gain a majority.\u00a0 So in the \u201csausage factory\u201d of Congressional legislation, the ACA was created.<\/p>\n
There were lots of \u201ccarrots:\u201d items that made the ACA palatable to American citizens. Insurance companies were required to cover people with pre-existing conditions without charging them additional fees, and parents were allowed to maintain coverage of adult children until they were twenty-six.\u00a0 The ACA also allowed for a major extension of government health coverage for low income folks; the Medicaid expansion provided health coverage for millions.\u00a0 And the ACA provided for insurance independent of employment, so that folks could change jobs and maintain coverage, without the extreme fees of \u201cCobra.\u201d<\/p>\n
But with \u201ccarrots\u201d there had to be \u201csticks.\u201d\u00a0 All of the above benefits certainly increased costs; in order to offset them, the ACA expanded the \u201cpool\u201d of folks required to have health insurance to \u2013 everyone. This meant that those who were healthy and had a high enough income to pay taxes and chose to go without insurance, now were required to either buy insurance or pay a tax: the \u201cindividual mandate.\u201d\u00a0 On an actuarial level they were less likely to need coverage, so that their payments went to offset the additional costs.<\/p>\n
Insurance companies didn\u2019t lose all their profitable perks. They were able to keep insurance coverage on a state-by-state basis, limiting the \u201csize of the pool\u201d for ACA insurance.\u00a0They also maintained the 80% of coverage that was privately based through employment, though they had to follow the new ACA regulations.\u00a0 And, of course, they could withdraw from offering ACA coverage in areas that weren\u2019t profitable.<\/p>\n
President Trump, through executive action, was able to end the individual mandate.\u00a0 By doing so, he removed the \u201cstick\u201d of the ACA.\u00a0 He used the time worn excuse for cutting government benefits:\u00a0 he was \u201cfreeing\u201d people from government regulation.\u00a0 It allowed the healthy to go without insurance.\u00a0 Costs for ACA insurance increased, as the \u201cpool of insured\u201d grew smaller and sicker.\u00a0 Republicans then claimed that the ACA didn\u2019t work, was too expensive, and had to be abolished.<\/p>\n
It\u2019s two days before election day.\u00a0 I have had the opportunity to travel in the past couple of weeks:\u00a0 Ohio, Pennsylvania, West Virginia, North Carolina, South Carolina and finally Florida.\u00a0 In this tense election season, there has been commercial after commercial for hotly contested House and Senate campaigns.\u00a0 Republican after Republican now claim to support insurance for pre-existing conditions without additional costs, as well as many of the other \u201ccarrots\u201d of the ACA.\u00a0 But they offer no plan to cover the costs, the \u201csticks\u201d that made the ACA work.\u00a0They simply say: \u00a0\u201cI\u2019m for pre-existing insurance coverage.\u201d<\/p>\n