In the movie, “Gone with the Wind,” Scarlett proclaims that she’ll “think about it tomorrow.” While a catchy movie line, putting off thinking about predictable problems may not be wise for Obamacare.
For Obamacare, tomorrow is not so far off that being distracted by the pettiness of politics and flamboyant demands for repeal or self-righteous claims of success should distract us from some sobering facts.
It is asserted here that Obamacare as it currently exists will begin to self-destruct by 2019, if not sooner in terms of the goals that persuaded the American people to stand behind it.
First and foremost, it was designed to get people insured as a means of improving access to affordable and quality health care. Second it was hailed as a means of doing away with the risk that each of us was one illness away from financial ruin.
But these goals will likely not be achieved by Obamacare, and Obamacare as it was promised will never materialize. These problems have been observed from the beginning and today, the risk is even worse because of the very government that enacted Obamacare.
Even by their own “standards of success,” Obamacare will likely flop for the same reason that Republican ideas will flop, our system is an unsustainable blend of single-payer and taxpayer subsidized health insurance and health care for some that depends on the contributions of all for sustainability.
It is a stark choice under our current system, which Obamacare changes little, we can only choose one, single payer, government-subsidized OR private insurance for all.
In my opinion, when it comes to doing away with “entitlement” programs, again it must be all or nothing, all taxpayer subsidies to health plans for governmental workers at the federal and state level should be wiped out along with all single-payer plans such as Medicare and Veterans benefits.
It sounds cold-hearted, but no more cold-hearted than the inequalities we have now that promise to worsen under the cost-shifting way we handle health costs and health insurance costs under our current system, even pre-Obama.
I include all preferential health benefits, including veterans’ benefits, because citizens have PAID for Medicare all their working lives and it is no more cold-hearted to deprive those who have served our country of lifetime benefits for healthcare than it is to deprive the elderly of what they paid for and bargained for during their entire working lives.
Similarly, with new crackdowns on SNAP, cutting government spending on feeding our nation’s poor, we can hardly argue that having our military personnel, and other government employees participate in our general health insurance market instead of getting preferential treatment is not consistent with our nation’s values.
If you’re against entitlements, be against all entitlements. If you’re pro entitlements, be pro all entitlements and a taxation system that can support it.
It’s time for a little bluntness in the formula. I also include state and local government employee benefits subsidized by taxpayers because those plans provide benefits superior to those received by a state’s citizens, a model from the past, especially in those states that opted out of Medicaid expansion for their poorest citizens.
Finally, I support the all or nothing because what we have isn’t working and Obamacare’s newest version of cost-shifting likely won’t work either.
Therefore, single-payer, or no public insurance or publicly funded insurance. Make the choice instead of feeling good about using other people’s money for some and not all (as the Democrats do) or instead of feeling good about the free market for some but not all (as the Republicans do).
Hopefully some of those who receive benefits under taxpayer subsidized or government subsidized benefits will realize that while they may vote Republican they don’t really support Republicans when it comes to their own health benefits. Similarly, for those who support Obamacare, and find that they are going to be paying more than they were before in many cases because of cost shifting, and certainly over time, (such as Unions are discovering), they’ll stop presenting Obamacare as anything but what it is, a cost-shifting enterprise that is unsustainable.
As in all cases, recognizing the problem is important. So, beyond opinion, is there ANY indication that Obamacare will self-destruct? I believe there is.
As a basis for this discussion below, search for the cms.gov article of April 22, 2010, a memo from Richard S. Foster, Chief Actuary at that time, on the subject of “Estimated Financial Effects of the ‘Patient Protection and Affordable Care Act,’ as Amended,” and you’ll find a discussion of the impact of PPACA.
Here’s my assessment of worse (-) or better (+) under Obamacare:
(-) If you’re well and you use Obamacare for preventive checkups and tests. Why worse off? Because at current price levels, it’s likely that you’ll pay more in premiums than what you would have paid by simply going for a checkup or preventive test.
(However, I believe that by requiring insurance to pay for some of these tests and checkups without copayments or coinsurance that the price for these preventive checkups and tests will go up so that in a few years you won’t be able to afford them without insurance, also making us worse off.)
(+) If you are eligible to use an insurance exchange and you qualify for insurance premium subsidies and credits, Obamacare works for you…for awhile. While insurance premium prices are enormous, with Federal contributions (which you can calculate using Kaiser subsidy calculator), you likely won’t end up financially suffering this year.
(-) If you are eligible to use an insurance exchange and you qualify for insurance premium subsidies and credits, your perks likely won’t last as long as you think. Obamacare does NOT institute either a policy or a plan for skyrocketing health care costs outside of Medicare in terms of changing the “whatever the market will bear,” and therefore health insurance costs will keep rising as health care costs keep rising in a never-ending chase. By 2019 it is likely that for most people, the health insurance exchange will NOT save you significant money on premiums as your “share” grows.
In 2010, in the memo cited above, Mr. Foster noted that “after 2018, if the Federal cost of the premium and cost-sharing subsidies exceeded 0.504 percent of GDP, then the share of Exchange health insurance premiums paid by enrollees below 400 percent of the FPL [Federal Poverty Level] would increase…” The result? “…the enrollee share of the total premium would generally increase in 2019 and later.”
(-) Those covered by employer health insurance plans will drop over time as employers shift employees into the health exchange. This was stated in 2010, not as a crystal ball analysis, but based on the math that Democrats used to justify Obamacare.
“Employer-sponsored health insurance…by 2019, an estimated 13 million workers and family members would become newly covered as a result of additional employers offering health coverage, a greater proportion of workers enrolling in employer plans, and an extension of dependent coverage up to age 26.” (Foster memo 4/22/10)
BUT the memo stated that “…a number of workers who currently have employer coverage would likely become enrolled in the expanded Medicaid program or receive subsidized coverage through the Exchanges…many part-time workers could obtain coverage through the Exchanges or by enrolling in the expanded Medicaid program…per-worker penalties assessed on nonparticipating employers are relatively low compared to prevailing health insurance costs. AS A RESULT, THE PENALTIES WOULD NOT BE A SUBSTANTIAL DETERRENT TO DROPPING OR FORGOING COVERAGE.” (Emphasis added).
In 2010, Mr. Foster noted that the small amount of the employer mandate penalty likely would not incentivize employers to provide insurance.
Since the employer mandate penalty like the individual mandate penalty is supposed to generate some funds for the Federal government, the problem of how long it will take for Obamacare to self-destruct is shortened since the employer mandate delay of one year.
Further, Foster concluded that by 2019, there would be a reduction of people with employer-sponsored health insurance by 14 million, so combined with the estimate that 13 million more people would gain employer health insurance that means “…1 million” FEWER people would have employer-sponsored health insurance in 2019.
Mr. Foster did not incorporate the “glitches” we’ve seen such as employers reducing the number of hours worked by employees to avoid providing health insurance, or the fact that employer insurance plans in some cases are raising premiums for dependents making health insurance unaffordable for employees to purchase for their dependents, and therefore the number of individuals eligible for employer-sponsored health insurance will probably be less than the one million less that Mr. Foster estimated in 2010.
(-) When the Supreme Court decided in 2012 that Medicaid expansion under the PPACA was an option and could not be a mandate, it shot Obamacare in the foot because Obamacare’s “get everyone insured” goals anticipated that by expanding Medicaid coverage about 18 MILLION would be insured under this expansion.
So, as Mr. Foster stated, “Of the additional 34 million people who are estimated to be insured in 2019 as a result of the PPACA, a little more than one-half (18 million) would receive Medicaid coverage due to the expansion of eligibility…” (Foster memo 4/22/10)
The estimated number of people who would have health insurance based on Medicaid expansion that went from required to optional will be much smaller than it was anticipated to be because already 22 states have opted out, meaning that the people who would have been insured will not be insured.
(+)Allowing children to remain on their parents’ health insurance, the group of 19 to 25 year-olds, represented the group with the largest reduction in uninsured (See “Census: Uninsured Numbers Decline as more Young Adults Gain Coverage,” KHN, Phil Galewitz, 9/12/12) BUT
(-) I would not count on this number remaining steady as insurers implement the 2014 provisions of Obamacare that authorize increased amounts charged to young and that impose no limits on how much can be charged for employee’s dependents for health insurance, which will mean many parents can no longer afford to carry this health insurance for their young adult children.
This will likely leave young people in a worse position than before because Obamacare has raised their health insurance premiums by LAW, no longer allowing young people to be charged based on a 5:1 difference but instead only a 3:1 difference, raising the least young people can be charged for health insurance.
It seems likely that without new ways of getting money from citizens to support Obamacare that the program will change. The choices will be to increase the support by the many for the few, as it’s set up now, and as it’s been for decades, or support by everyone for everyone (single-payer for everyone) or support of none and letting the program self-destruct.
Most of all Obamacare highlights that there is really not an effective “compromise” in solving the problems it intended to address, getting people insured and getting people insured so that they’re not one illness away from bankruptcy.
