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When 911 Doesn’t Work for the ACA

If the Affordable Care Act were a patient, it would need a defibrillator about now.

As Managing Editor Susan Rupe points out in this month’s feature article, things are not looking great after the second ACA enrollment. More people might have health insurance, but they are paying substantially more for care. Health insurance agents are basically donating time to help people deal with insurance exchanges.

The program has widened the pool, which was one important goal, but it is failing the “affordable” aspect. In fact, families are struggling with paying not only premiums, but deductibles and copays as well. Families can lay out more than $20,000 in a year, even if everybody is relatively healthy.

The ACA needs reform, but no one is going to do it. Republicans want the whole thing repealed, and Democrats don’t want to open the door on adjustments because Republicans are likely to seize that opportunity to destroy the program.

As of print time, the GOP was preparing an ACA replacement apparently based on The Patient Choice, Affordability, Responsibility and Empowerment (CARE) Act from last year. It offers tax breaks (subsidies), market reforms and medical malpractice lawsuit limits. The act has some good ideas but is built on a shaky foundation. It requires insurance companies to accept pre-existing conditions and limits what companies can charge for premiums, but it does not include an individual mandate. Odds are good that young and healthy people would jump out of the risk pool. It is not clear how insurance companies can afford to do all those things and insure only the sickest of people without charging enough to cover those costs.

The few market reforms in the bill would mean nothing because few insurance companies would be able to participate.

Essentially, no matter what the answer is, we would trade one set of problems for another. Any significant program will require fixing. As I have said before, the ACA was a market-based answer to what were significant access issues.

But we still have the problem of paying the most for health care but having the worst outcomes among industrialized nations.

Is starting from scratch a real answer? If it is, would it be possible for both parties to bring their good ideas to the redrafting table? Admit it, you at least chuckled while reading that last question. But a real bipartisan solution would ensure that one side does not devote its every waking moment to destroying the program.

That opportunity might arrive this year with the Supreme Court looking at aspects of the ACA. A few possible decisions could derail the program. Obviously, the majority of Congress would not be likely to fix those issues, but instead would use the opportunity to scrap the ACA.

The process just to get a new program established would be daunting. That would be followed by a years-long rollout with all its snags that about half of the Congress would be unhelpful in fixing.
In the end, if the new plan is similar to the CARE Act, I don’t see how our problems would be solved. I could be wrong in that estimation, but it is certainly possible that the nation would endure several more years of health system agony just to have the same access and affordability problems.

One good outcome would be restoring commissions for insurance agents, assuming those restrictions are removed. That is good news, if insurance companies are still in the market.

The fact remains that if legislators require insurers to ignore pre-existing conditions, restrict what they can charge in premiums, and allow young, healthy people to opt out of the risk pool, simple logic would tell us that carriers would find that very difficult to bear. This would be, in fact, the worst of all possible worlds for private insurance companies. What then? Single payer? That sure would be ironic – a decade and a half of squabbling to arrive at a system no one, Republican or Democrat, dared to even discuss.

The future is unclear. But what is apparent is this: The ACA needs assistance. Its chances are fading fast. We can only hope that the ambulance doesn’t end up on the side of a road with the driver and medics arguing over the best route to get there.

Steven A. Morelli is editor-in-chief for InsuranceNewsNet. He has more than 25 years of experience as a reporter and editor for newspapers, magazines and insurance periodicals. Steve may be reached at [email protected] Follow him on Twitter @INNSteveM. [email protected].

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