Friday, January 8, 2016

Obamacare Is Working ... Pass It On

Ever since Barack Obama made universal health insurance a defining feature of his first term in office, the Republican Party has engaged in a relentless campaign to destroy what we now refer to as “Obamacare.” During the bill’s movement through Congress, they threw up every legislative obstacle, ginned up protests and rowdy town halls, and attempted to sow fear with ominous warnings of death panels and government bureaucrats coming to pull the plug on granny. Once the law passed, immediate legal challenges cropped up attempting to stop implementation of the law, questioning its constitutionality, and otherwise gumming up the arteries of the legal system in a Hail Mary attempt to stop millions of people from gaining health insurance. Just this week, Congress held its 62nd vote to repeal Obamacare, finally getting its symbolic victory so that the President can stamp “VETO” when it lands in his inbox. 

It was an odd and discomfiting experience, what with the fact that the law was modeled on an idea originally proposed by the Heritage Foundation and promised to hand health insurers millions of new customers all while maintaining our inefficient, privately-run system for health care delivery in the country. Regardless, weeks and weeks of coverage were provided on everything from a glitchy website to supposed insurance death sprials to claims that the new law would destroy jobs. All reported breathlessly by a media more than happy to ape Republican talking points without ever digging into their veracity. Of course, none of these things occurred, not that you would have noticed because the media had already moved on without bothering to issue corrections. Chuck Todd demanded an apology from President Obama when healthcare.gov was not working, but never proferred a mea culpa of his own once the program was up and running smoothly, helping millions find health insurance.

Comes now an editorial in the Washington Post that examines the three-legged stool of measuring Obamacare’s success: enrollment, cost control, and employment. On all three scores, the Affordable Care Act has delivered – big time. 

Enrollment: Before the Affordable Care Act passed, an estimated 18.5 percent of the adult population in America under the age of 65 was without health insurance. In 2015, that number dropped to 10.5 percent, a reduction of about 45 percent. As the editorial notes, that percentage would be even lower if all 50 states, instead of just 30, had expanded Medicaid coverage under the ACA. It is worth noting that if all 50 states had expanded Medicaid, the roughly 9 percent of American adults under 65 without health insurance is in line with pre-ACA estimates provided by the Congressional Budget Office. 

Cost Control: Here we have two points to consider. The first is whether the ACA did anything to rein in insurance rates that used to go up considerably year-to-year; the second is what impact the Medicare cost control measures included in the ACA did to reduce costs in that program. On both counts, the ACA has succeeded. Prior to Obamacare’s passage, it was estimated that health care expenditure rates would increase by 5.5 percent in 2013 and 7 percent in 2018. In reality, expenditures only increased 3.6 percent in 2013 and are now only estimated to go up by 5.3 percent in 2018 – huge cost savings. Similarly, the rise in premium rates and medical costs since the passage of the ACA have been well below what they were in the decade prior to its passage and the actual costs are lower than what were estimated by the CBO when the law passed. 

On the Medicare front, the cost savings should make any green eyeshade deficit hawk swoon. In 2009, the CBO expected the government to spend $723 billion on Medicare in 2015. The actual amount? $634 billion - $90 billion less than predicted. Extrapolate those savings out over a decade and you have “saved” almost $1 trillion. Not too shabby. 

So, the Affordable Care Act has cut the number of uninsured by nearly half, cost less than predicted, and saved Medicare tens of billions of dollars. But what about jobs? Republicans kept telling us that Obamacare would be a jobs killer. Not so. The past two years have been gang busters for employment. The jobless rate is now at just 5% and the economy has created millions of new, mostly full-time jobs in the process. 

That the good news is largely unreported is unsurprising. Humdrum stories of government functioning as intended (and even a little better) are not nearly as interesting as whatever insult Donald Trump has lobbed at an opponent today, but to the people who have benefitted from the Affordable Care Act, I suspect this is, as Vice President Biden said, a big fucking deal.

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