Republicans don't get a pass on their failures regarding Obamacare and the President doesn't get a pass on his apparent non-understanding of health industrial complex issues.
That said, in my opinion (obviously) it is merely a political ploy that for elections Democrats are recycling their talking points and sales tricks about Obamacare to find some, any unifying thought, idea or goal around which to sell their party for midterms. Democrats are clearly using their old playbook and relying on the "stupidity of the American voter" as per the now infamous 2014 words of Obama pal and Obamacare architect Jonathan Gruber.
The appalling use of the crisis of affordability, access, cost and quality of the American healthcare system politicized by Obama and mishandled by Republican counterparts, especially the likes of Paul Ryan is a stain on both political parties' lawmakers who separately brag about their accomplishments while sucking off the teat of the American public for their public employee benefits for which we pay up to 75 percent of their premiums and who by Obama special legislation were exempted from Obamacare.
For consumers, neither party means much for Obamacare in terms of the election, so you can ignore the nonsense. For the year 2019, this is what we're looking at:
First, Obamacare is still law.
Second, while the individual mandate is also still law, the penalty amount has been reset to zero, so if Democrats win, you can bet that number goes back into real dollar amounts. For 2019, currently, if you don't purchase health insurance you have still violated the individual mandate, but the penalty amount is zero. Democrats will change that.
Third, pre-existing condition coverage in its ugly current Obamacare form is still the law, you cannot be denied coverage nor charged more in premiums for health insurance. This one requires some attention, because Democrats are "warning" that Republicans will get rid of pre-existing condition coverage. Without repeal of Obamacare, that isn't happening. If Democrats win, if Republicans win, it is without ever using the word "definitely," extremely unlikely it will happen.
The reason it's ugly is because that agreement by insurers not to deny coverage for pre-existing conditions was part of an anti-consumer alliance formed between government and insurance companies by Obama when he agreed to the insurance industry lobby's 2008 proposal to NOT deny coverage for pre-existing conditions as long as government required people to purchase the consumer financial product of health insurance…The individual mandate.
The insurance industry made a proposal to Republicans too, because hey, you never know and proposed a CONTINUOUS COVERAGE requirement in exchange for covering those with pre-existing conditions. In this privatized version, instead of the government penalizing and imposing a tax on people who didn't buy the consumer financial product of health insurance as per Obamacare, insurance companies would impose the penalty for people who had gaps in coverage.
In some ways this could be worse because the continuous coverage penalty might be higher than the Obamacare tax penalty, and/or does not have its duration of penalty covered by law, eg whether higher premiums could be charged like the Obamacare penalty for the year in which there was an insurance coverage lapse or whether that would go on indefinitely.
This year, with the individual mandate still on the books, but its amount being zero, it will be interesting to see whether insurance companies institute continuous coverage provisions to further force people to purchase their products.
The "ugliness" of the pre-existing condition deal, in addition to forcing people to purchase the consumer financial product of health insurance or face a tax penalty, is that it also rendered Obamacare an ageist piece of legislation.
Instead of prohibiting denial of coverage and putting a limit on how much more could be charged to people with pre-existing conditions in premiums to purchase health insurance, eg 1.5 times premium, etc. Obamacare outlawed any premium surcharges on any traditional cost centers for insurance companies, those who they figure they'll pay out more for, including those with pre-existing conditions, obesity, alcoholism, drug problems, tobacco users.
Instead, Obamacare singled out two groups for higher premiums ONLY, those who use tobacco and those who are older. While tobacco users are not a protected class, age has traditionally been a protected class.
Resorting to the insurance company 'metrics' regarding who they're likelier to pay out on, arguably, those who are older might need more medical care and services and therefore cost insurers more, is always a justification for higher premiums, but singling out individuals based on age while outlawing other cost centers, including those with pre-existing conditions, alcoholism, drug problems, obesity really renders Obamacare legislation ageist.
Nevertheless, under Obamacare, those with pre-existing conditions can not be charged more to obtain insurance (no increased premiums) and cannot be denied insurance coverage. I agree with no denial, I disagree with no premium increase, but both remain the law.
But Obamacare isn't rainbows and unicorns. Those with pre-existing conditions and everyone else felt the heat from insurance companies as OUT OF POCKET costs soared under Obamacare in terms of amounts consumers had to pay for DEDUCTIBLES, COPAYS and COINSURANCE went up. These are the costs of USING rather than obtaining insurance. And as part of its alliance with its new partner, the insurance companies, government cooperated with insurers and consumers saw their OUT OF POCKET MAXIMUM, the OOP go up dramatically.
This benefits year, 2019, if you have self-only coverage, the cost of using your insurance for healthcare will be up to $7,900 for self-only coverage and $15,800 for couples and families and that's IF your insurance plan covers your services or medications.
Obamacare didn't do anything regarding expensive medications leaving insurance plans free to omit drugs from their "formularies," and leaving anyone unlucky enough to need an uncovered medication not only on the hook for the soaring drug costs, but those costs don't go into OOP, they're invisible for insurance purposes so that you can spend everything you have and NEVER reach an out of pocket maximum. If something's not covered by a plan, the plan will NEVER cover its costs no matter how much you pay. That is still law.
Obamacare also made up for some of its Obamacare spending by allowing the 7.5 percent threshold for medical expense deductions to lapse resulting in consumers having to spend more than 10 percent of their income on medical expenses before that deduction became available (rather than more than 7.5 percent of their income). That is still law.
All these provisions of Obamacare work against those who need to USE their health insurance, rather than merely purchase it (premium costs).
The ACA also permits higher premiums to be charged to young-healthies in two ways, first by increasing how much young-healthies pay in premiums to a new ratio of 3:1 rather than 5:1 old person premium/young person premium ratio. Meaning that old people can be charged three times as much rather than up to five times as much as younger people, increasing the amount that could be charged to young-healthies and by including the discriminatory old person surcharge of a permissible 1.5 times premiums everyone else pays which naturally raises the amount that could be charged to young people based on the revised ratio of 3:1. This remains the law.
We've already seen astounding increases in health insurance costs both in premium and out of pocket payments during Obamacare's duration. For those who argue otherwise, simply look at data, concrete numbers (rather than warnings and guesses that things might have been worse fantasies) for 2014.
In 2016, as young-healthies and others looked for alternatives to the costs of qualified Obamacare health plans and looked to SHORT TERM LIMITED DURATION plans, the Obama Administration RESTRICTED THE AVAILABLITY of those plans trying to force more people onto exchanges explaining: "Some issuers are now offering short-term limited duration plans to consumers as their primary form of health coverage for periods that last nearly 12 months, allowing them to target ONLY THE HEALTHIEST CONSUMERS…" The Republicans have changed this Obama 2016 additional restriction and expanded the availability of Short Term Limited Duration, STLD or STLDI plans.
There was another jump in costs and an exodus from health exchanges in late 2016 for the 2017 benefits year when the payoffs provided by the federal government to insurers, risk corridor payments and reinsurance payments EXPIRED AS PER THE AFFORDABLE CARE ACT. This is still the law, those payments expired in 2016 as Obamacare provided for in 2010.
We must remember, Obamacare has two prongs, the exchanges part and the expanded Medicaid part, which expands the availability of Medicaid to people who are earning money, but not enough money to be bound by the requirements for insurance purchase under Obamacare. The expansion is different from traditional Medicaid in two ways, first, that richer people are eligible than formerly and secondly that the federal government pays for a larger portion of the coverage than traditionally. This is still law.
What is interesting about expanded Medicaid, is that because it does not address OBRA '93, (the Omnibus Budget Reconciliation Act of 1993), the provisions of that law REQUIRING states to go after the estates of people older than aged 55 who use Medicaid, puts in jeopardy the estates of older people who seek to use Medicaid. The choice is a bad one for older Americans as is made worse as some aged 55 and older might be newly eligible under expanded Medicaid rules. Nevertheless, both OBRA '93 and expanded Medicaid in states that adopted it both remain law.
Both parties have failed the American public when it comes to the healthcare industrial complex while protecting themselves off our dime, an inarguable truth that makes it surprising that either party would use Obamacare, for or against as a campaign point during midterms.
