Sunday, December 22, 2013

When will we admit that the problem with Obamacare is not the "roll-out"?

The difficulties with the healthcare exchanges makes an easy target, but the reality is that the main problem with Obamacare is structural, not technical.

Even the New York Times gets it:

An analysis by The New York Times shows the cost of premiums for people who just miss qualifying for subsidies varies widely across the country and rises rapidly for people in their 50s and 60s. In some places, prices can quickly approach 20 percent of a person’s income. 
Experts consider health insurance unaffordable once it exceeds 10 percent of annual income. By that measure, a 50-year-old making $50,000 a year, or just above the qualifying limit for assistance, would find the cheapest available plan to be unaffordable in more than 170 counties around the country, ranging from Anchorage to Jackson, Miss. 
A 60-year-old living in Polk County, in northwestern Wisconsin, and earning $50,000 a year, for example, would have to spend more than 19 percent of his income, or $9,801 annually, to buy one of the cheapest plans available there. A person earning $45,000 would qualify for subsidies and would pay about 5 percent of his income, or $2,228, for an inexpensive plan.
This reality is hitting home for people who had naively trusted politically based assertions that the Affordable Care Act would improve their health insurance situation:
David Oscar, an insurance broker in New Jersey, another high-cost state, said many of his clients had been disappointed to learn that the premiums were much more expensive than they had expected.
“They’re frustrated,” he said. “Everybody was thinking that Obamacare was going to come in with more affordable rates. Well, they’re not more affordable.” 
And upon which group are the majority of these frustrations centered?
The Chapmans acknowledge that they are better off than many people, but they represent a little-understood reality of the Affordable Care Act. While the act clearly benefits those at the low end of the income scale — and rich people can continue to afford even the most generous plans — people like the Chapmans are caught in the uncomfortable middle: not poor enough for help, but not rich enough to be indifferent to cost. 
In other words, the ACA is structured to send middle-class insurance rates UP, and a lot of Obamacare advocates are suddenly quite open and unrepentant about that fact, pretty much as if they'd expected it:
Ninety percent of the country’s uninsured population have incomes that fall below that level, according to one recent analysis. As a result, the subsidies “are well targeted for people who are uninsured or underinsured,” said Sara R. Collins, an executive with the Commonwealth Fund, a private foundation that finances health policy research. “That is really where the firepower of the law is focused.”---snip--Some experts dismissed the varying effects of the income cutoff, saying the law’s main elements benefit most of those who could not previously buy insurance. 
“I think that job one was to make sure that the people who clearly have the greatest difficulty affording premiums receive the greatest help,” said Ron Pollack, the founding executive director of Families USA, a consumer advocacy group that favored the law. 
To avoid creating such steep cliffs, federal officials would have had to spend more money on the subsidies, said Larry Levitt, an executive with the Kaiser Family Foundation, a nonprofit research group that is closely following the health care law. Subsidies would have been higher, and could have been more gradually phased out, he said. The design “was largely driven by budgetary decisions,” Mr. Levitt said.
Got that?  Keeping health insurance affordable for the middle class was never actually a priority say experts from the Commonwealth Fund, Families USA, and Kaiser Family Foundation.

Put most simply:  forcing the middle class to pay more for health care (while claiming stridently that costs would go down) is not a bug but a feature of Obamacare.

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