We have a black and white showdown staring us in the eyes. Folks who simply want to kill a flawed statute – the Affordable Care Act – rather than try to fix it are willing to shut down the federal government (as much as they can) and slam the Republicans’ standing to generate the national constituency to elect a president. There are no politicians who believe that Obamacare doesn’t need fixing. No one! But while every seminal statutory change – from Social Security to civil rights legislation – has had one or more opportunities for fine-tuning in subsequent “fix-it” legislation, the Affordable Care Act does not have that opportunity. Repeal is the only direction that the GOP-dominate House will permit. We never hear that “fix-it” alternative from the factions in the battle.
The objections to the statute are many: The mandate for coverage has been its most vulnerable provision. Too many younger workers – feeling the invincibility of youth – cannot bring themselves to write the checks to secure the mandatory coverage and hate the notion of paying any fines associated with that decision. Without the mass of coverage for the young, the system cannot amortize the costs of healthcare and cannot work the overall savings that the plan is determined to implement. With younger workers also bearing the blunt of the new lower wages that Americans are earning these days, they have a point. Solution: raise the deductible and allow policies just for disaster coverage one or incorporate a lower rate into automobile insurance, which will better access of this demographic segment. There may have to be some additional interim government subsidies here (beyond those at the poverty level), based on income from those who are employed, until this economy really starts positively impacting working Americans… and not just investors.
While cheaper-than-almost-everyone-else Wal*Mart is relenting and is restoring workers to full-time status, the GOP correctly points out how many employers are avoiding writing the healthcare checks by making sure the bulk of their workforce now qualifies as uncovered part-time workers (under 30 hours a week). They are cutting workers from regular full-time jobs and moving them to part-time or outsourcing work to smaller contractors without those benefits. Folks are losing earning power. So just fix the problem! Other than excluding interns who are part of a qualified regular academic program, make employers pay for healthcare for all employees (including contributions for contractors), but base that payment ratably (based on a 40 hour week) on any hours worked. That money can be applied to the employee’s/contact employee’s choice of healthcare exchange or regular insurers.
There are going to be sacrifices to those who have to access healthcare those these new exchanges, scheduled to take effect on October 1st, since the policies will have limitations. “When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.
“Some consumer advocates and health care providers are increasingly concerned. Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.” New York Times, September 22nd. In lower income communities, the number of facilities that are or will be part of the program may be harder to get to and offer fewer services. While the cost of these exchanges will drive monthly costs down to between averages of between $100 to $400 per month, depending on federal subsidies, the fact is that some healthcare costs will fall out of the system. Again, some form of disaster coverage, on top of general coverage, may be required.
If your state didn’t create a state exchange (and 36 states left that to the feds), and you are looking at the federal exchange costs, they are pretty reasonable. “For a benchmark plan — the second-lowest-cost ‘silver plan,’ covering 70 percent of projected medical costs for a typical consumer — the average premium nationally will be $328 a month for individuals, the administration said in a new report…. For a family of four with an annual income of $50,000, the administration said, monthly premiums for the second-cheapest plan will vary widely, averaging $600 in Arizona, $800 in Georgia, $961 in Indiana, $1,069 in Mississippi, $859 in New Hampshire, $943 in New Jersey and $656 in Utah.” New York Times, September 25th.
If you are lower-income qualified, those costs can drop significantly: “Under the 2010 health law, most people buying insurance in the exchanges will be eligible for federal subsidies in the form of tax credits. Taking account of these subsidies, the administration said, a family of four with income of $50,000 will generally be able to buy a silver-level plan for $282 a month, while a 27-year-old with income of $25,000 will be able to get such coverage for $145 a month.” NY Times. But the number of insurers are limited, generally one or two providers in each state. It isn’t perfect, the coverage isn’t as complete as purely private plans, but it’s a decent start.
There are and will be more problems to solve along the road, but in this world of lower wages, lots of outsource contractors providing zero benefits and a need for younger workers to grow their own business just to have jobs, we have real issues on how to pay for healthcare while driving down the costs. The GOP already vetoed our ability to access cheaper prescription drugs from Canada or Europe – making the big pharmas, who paid lobbyists well to insure that option died, smile – or direct government healthcare option, making sure that the for-profits would be the beneficiaries of the new law.
Compromise got us the new law. Compromise can fix the flaws. But compromise requires dialog and a willingness to help make things work. Until the gerrymandered House is reconfigured by the next (distant) Census, expect the government to stop and drag on for years. Healthcare is just one “I’ll hold my breath until we all turn blue” issue. There will be more.
I’m Peter Dekom, and perhaps if we don’t have the government we want, we are getting the government we deserve!
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