BS or Not: Affordable Care Act Report Card

Interesting conundrum: take a flawed statute that an angry conservative House of Representatives has unsuccessfully attempted to repeal 54 times but is unwilling to repair at any level, release it to be deployed in a battery of states with their own mandates and prerogatives and watch it float or sink depending on local receptivity.

 

While every seminal piece of federal social legislation in American history has been submitted to Congress for repair, usually multiple times, the Affordable Care Act (Obamacare) has been repeatedly denied that opportunity. While the Administration has attempted to use executive orders to create exemptions, extensions and “amendment by enforcement priorities” to ease the statutes flaws, the real success or failure of the program has pretty much been determined by state-by-state reaction. With a Supreme Court ruling giving states more rights than the statute originally intended (on Medicaid), local enrollment has been deeply impacted by state decisions on implementation… and by the technological competence level of states that have created their own healthcare exchanges.

 

“The online insurance marketplace in Oregon is such a technological mess that residents have been signing up for health coverage by hand. In Texas, political opposition to President Obama’s health law is so strong that some residents believe, erroneously, that the program is banned in their state… But in Connecticut, a smoothly functioning website, run by competent managers, has successfully enrolled so many patients that officials are offering to sell their expertise to states like Maryland, which is struggling to sign people up for coverage… [Note: Maryland seems about to replace their system with Connecticut’s]

 

“[A] review of state-by-state enrollment data and other research, as well as interviews with patients, advocates, health policy analysts, elected officials, supporters and critics of the Affordable Care Act, suggest that, for consumers at least, the state of health care under the national law depends almost entirely on where a person lives.

 

“Some states have had a flowering of competition among insurers, including nonprofit co-ops — entirely new entities that are capturing the largest market share with low prices and remaking the coverage landscape in places like Maine. But in other places, including parts of states like New Hampshire and West Virginia, consumers have hardly any insurance choices at all.” New York Times, March 27^th.

 

The President tell us that 6 million people have signed on for healthcare under the act (below the 7 million targeted), and that 3.5 million American have been added to Medicaid as that program has been expanded by that statute (where states have accepted this expanded role). Sign-ups among certain minorities and the “invulnerable” younger demographics remain below expectations, and as a result, the higher use older demos that have signed up are probably going to force a greater cost-push than originally projected. But the statute really seems to succeed or fail almost entirely on how it is implemented (especially in states have actually created their own exchanges, allowing “fixes” to be more easily implemented). Hence conservative states (where they oppose the law) have created their own self-fulfilling prophecy of failure while blue states have, for the most part, created programs that work.

 

In the panoply strategies building towards the approaching mid-term elections, the GOP path appears to be based on the negative perception of Obamacare among a large segment of the electorate… often biased by their state’s literally following a failure path and then using that self-directed failure to make the case against Obamacare.

 

When it comes to such major issues, it would be nice if we could approach the problems – and of course there have been problems – objectively. I guess that’s not going to happen. “‘The whole narrative about Obamacare — ‘Will they get to six million? What is the percentage of young adults going to be?’ — has almost nothing to do with whether the law is working or not, whether the premiums are affordable or not, whether people think they are getting a good deal or not,’ said Drew Altman, president of the Kaiser Family Foundation, whose analysts are closely tracking the measure… ‘It’s almost like trying to predict the local weather from national averages,’ Mr. Altman said. ‘This is really now a state and local game, not a national one.’” NY Times. And just think of the mess that we would have if the Affordable Care Act somehow were repealed.

 

I’m Peter Dekom, and I am reminded about the four blind men describing an elephant, when they have only been allow partial contact with the beast.