Another Health Reform Update

With the second annual open enrollment period for the public health insurance exchanges underway, just how has that health reform law worked out.  It might be appropriate to briefly review the promises made to the “stupid” American voters in connection with the passage of the law.  The most prominent were that people would not see significant changes to their existing coverage, if anything, it would get better because of new mandated benefits; that their costs for insurance and care would go down; that many more people would have insurance; and in the midst of this significant change, quality would also improve.  The reality might seem a little different to most Americans.

1.  Premiums never went down, in the group or the individual market.  They have gone up, and one significant factor is the mandates in the reform law.

2.  For the current open enrollment period, according to the Administration and independent analyses, most people would have to pay a significant premium increase to stay in the plan they chose in the first open enrollment period.   The Administration’s response is to encourage people to “shop around” to see if they can find cheaper coverage.

3.  As a number of recent stories have noted, not only are premiums going higher, almost all plans actually purchased on the exchange have high deductibles and other forms of cost-sharing, which can deter appropriate use of care as well as inappropriate.  Health insurance is not making health care more affordable for many people.

4.  The subsidies which are supposed to help many people cope with the new mandate to buy insurance are turning out to be less helpful than anticipated because they are tied to a level of coverage which while not cheap is less expensive than anticipated, since it has high cost sharing.  Saves the public tax dollars, but doesn’t make health insurance more affordable.

5.  The Medicaid expansion, where accepted by the states, is enrolling many more people, but they are having difficulty finding doctors and other care providers; the providers feel stressed by low Medicaid payments and audits are beginning to show that many people got Medicaid coverage who weren’t entitled to it.  The fairness of giving gold-plated coverage to Medicaid recipients while many hard-working people struggle to afford even crappy coverage continues to elude me.

6.  Outside the Medicaid expansion, the reform law hasn’t come close to providing coverage to the number of Americans projected during the passage of the law and the Administration recently substantially lowered its projection of signups during the current period.

7.  There is no evidence that the law has done anything to improve quality of care or life for most Americans.  It has certainly greatly added to provider and consumer stress.

In fairness, the health care system is a difficult problem, and there is no easy or maybe any fix at all.  But the manner in which the law was passed and its grandiose lack of hubris make the Administration fair game for all the criticism that can be hurled at it.