It is hard to believe that the Patient Protection and Affordable Care Act (ACA), or Obamacare, was ten years old last month on March 23, 2010.  With the coronavirus dominating the headlines, there was little mention of it in the news and why not, much of what was promised did not come true. Remember we were told families would see their premiums decrease by an average of $2,500 per year?  Instead, premiums doubled for individual plans according to Heritage Foundation Senior Research Fellow Ed Haislmaier.

As Haislmaier also pointed out in his report "Premiums, Choices, and Government Dependence Under the Affordable Care Act:  A State-by-State Review" networks shrunk, deductibles increased, many states saw insurers leave their state, and more Americans became dependent on government for their care.  In 2017, several states had only one insurer like Alaska, Georgia, New Mexico, South Carolina, and Wyoming.

Obamacare’s heavy-handed mandates forced people to buy insurance plans and coverage they did not want or need, such as maternity or pediatric care for single men or mental health and addiction services even if someone has no need for these services.

Still, others claim Obamacare was successful because it increased the number of insured.  But most of that increase came through Medicaid expansion, which allowed healthy, childless, abled-bodied adults with incomes up to 138 percent of the poverty level to sign up for the joint state and federal healthcare program.  States that agreed to expand Medicaid received from the federal government 100 percent funding for the newly eligible individuals in 2014 through 2016.  That amount gradually dropped to 90 percent in 2020 and beyond.  

For traditional Medicaid, states receive an average 50 percent federal match rate for their enrollees.  Because money from the federal government for the expansion group is much more than the original Medicaid population of low-income children, pregnant woman, parents of dependent children, the elderly and those with disabilities, the states favor coverage for the expansion population.

But the biggest indication that Obamacare has failed is that its original supporters in Congress have moved on to Medicare for All.  Clearly, they believe the federal government did not interfere enough in our lives and want it more involved in deciding the kind of healthcare all of us will receive.

Fortunately, the Trump administration has made changes to Obamacare through regulatory reform that has helped to provide more choice in the healthcare marketplace and drive down premium costs.  For example, the Centers for Medicare and Medicaid Services (CMS) expanded the use of short-term, limited-duration healthcare plans that provide coverage just under 12 months that can be extended up to a maximum of 36 months.  These plans could be particularly helpful to those that have become uninsured during this difficult time.

CMS also has worked with states to take advantage of Section 1332 State Innovation Waivers, which ironically is found in Obamacare.  States can make changes to their ACA exchange plans but still meet the requirements required in the law.  Many states have created reinsurance plans that have helped to drive down premium costs while still protecting those with pre-existing conditions.  For example, Maryland citizens saw their premium drop 13 percent in 2019 and 10 percent in 2020.  Similar results have been seen in other states.

When we have passed the current crisis caused by the coronavirus, healthcare will remain a top issue in the 2020 election.  There will be a push for Medicare for All, which would cost a fortune by adding $32.6 trillion to federal spending for the first ten years and we would lose our private insurance.  Like most single-payer plans, the federal government would limit the demand for “free” healthcare by rationing, reducing payment to providers, and limiting choice.

One alternative to Medicare for All is the Healthcare Choices Plan 2020 and has the interest of several Republican senators.  Another alternative is the House Republican Study Committee proposal, “A Framework for Personalized, Affordable Care.”  Both plans take decision power out of Washington and give people more choice and control of the kind of health coverage they want, while protecting those with pre-existing conditions.

We should be thankful that we are in the most innovative country in the world when it comes to discovering therapies and providing healthcare.  We need to keep it that way.