Affordable Care Act Debate Misses Core Problem

Affordable Care Act Debate Misses Core Problem, Maura Carley, President, Healthcare Navigation, LLC
Politics aside, many of us are not as blessed financially as Mitt Romney to be able to forego Medicare. In my opinion, the Republican Presidential candidate is making a big mistake, one that many Americans can’t afford to make. Will the Affordable Care Act, now being debated by the Supreme Court make health insurance any more affordable? No, it will not.
The primary purpose of the Affordable Care Act is to cover more Americans not covered by a group plan.  However, so much of the seemingly endless debate about the (not so) Affordable Care Act misses a fundamental point – healthcare coverage is often unaffordable.  Assuming the Affordable Care Act survives this week’s Supreme Court scrutiny, healthcare coverage under the ACA will likely remain unaffordable for all those who don’t qualify for a subsidy and hence functionally unavailable to others who have to pay for their own coverage.

Earlier this year the Kaiser Family Foundation reported that the average annual premium for family coverage through an employer reached $15,073 in 2011.    In most situations in the U.S. when someone loses group coverage, they are entitled to COBRA, a temporary extension of group coverage paid for by the individual.   But those who have never had to pay for health insurance on their own are often shocked to learn what COBRA or other health coverage can cost so many choose to go without coverage.

In my view, the cost of coverage is the primary reason there are almost 50 million uninsured Americans.

My home state of Connecticut has led the country in efforts to reduce its ranks of uninsured citizens.  The law creating The Health Reinsurance Association, the country’s first high risk pool for those who couldn’t qualify for individual insurance due to pre-existing conditions, was passed in 1975.   But only 1558 people are enrolled in this program, a miniscule fraction of the estimated 385,000 uninsured Connecticut.  Premiums are unaffordable for most individuals.  For example, a 60 year old male who’s exhausted COBRA will pay $2129 per month for coverage.

Charter Oak, a more affordable option for coverage in Connecticut at   $446 per month for an individual currently has approximately 8000 enrollees.  As of March 1, 2012, the Connecticut Pre-existing Condition High Risk Pool Plan established pursuant to the Affordable Care Act and providing subsidized premiums had an underwhelming enrollment of 293.

So what’s the answer?  We need true reform which reduces the cost of our healthcare system rather than legislation which panders to every special interest group increasing costs and making coverage even more unaffordable.

What might reform look like?  We might abolish for-profit insurance companies and some of their offensive practices.  We’d pay a fair price for prescription drugs but not the highest prices in the world.  We’d be working community by community to reduce poverty and improve health by using nurses and other physician extenders and keeping people out of expensive emergency rooms for primary care.  We’d find alternatives to nursing homes for many of our oldest and most fragile citizens.  We’d move from fee for service medicine to integrated delivery systems that strive to evaluate and improve the care provided and can demonstrate their ability to do so.

The Affordable Care Act paternalistically assumes no one could possibly be responsible for their own or their family’s well care if it is associated with a copayment or coinsurance.  Some have even suggested that well care and contraceptive care are now “free.”  Nothing is free.  When copayments are eliminated, premiums increase.
As Shakespeare wrote, a rose is a rose by any name but calling something “affordable” or “reform” doesn’t make it so.