Functioning Health Exchanges

There has been a lot of understandable outrage over the troubles plaguing Healthcare.gov, the federal website for purchasing individual or family health insurance under the Affordable Care Act (aka Obamacare). Opponents of the law (Republicans), recovering from their self-inflicted wounds over the government shutdown, see this as evidence of the fundamental unworkability of the law, and of the folly of a “government solution” to a complex problem. Supporters of the law (Democrats) are terrified that the difficulty in buying insurance will dissuade the so-called “young invincibles” (healthy young people who have limited needs for health care services) from buying coverage. If that happens, and only the older and sicker among the eligible population buy insurance, then premiums may not cover the cost of services, forcing insurers to raise rates, which would further dissuade the healthy from buying coverage, setting off a possible “death spiral” of higher rates, and fewer people covered.

This is a real problem, and if news reports are accurate, there are lots of fingerprints on the “crime.” The President and The Department of Health and Human Services have promised a fix by the end of the month, and I hope they deliver.

Almost completely lost amid all the yelling and finger-pointing is the fact that each state was supposed to set up its own exchange. The federal health exchange, intended as a default or back-up, is taking on the work originally intended for these state-sponsored exchanges.  A map in the NY Times is a reminder that most Republican governors scuttled plans for their own state exchanges, just as they refused to expand Medicaid. Some of these state exchanges have had their own problems, but many are functioning as intended.

I can’t help but wonder about the connection. It seems like Republicans at the state and federal level have done their best to hamstring the implementation of the Affordable Care Act, and are now using the results to say the law was all a mistake in the first place. Seems to me that if your political philosophy is that “government is the problem,” then it is not hard to govern in such a way as to make that seem a reality.

What do you think?

3 thoughts on “Functioning Health Exchanges

  1. The exchanges aren’t really they problem. The problem is people are going to lose their plans and pay more for plans that have higher deductibles. As this reality starts to trickle out this legislation will be a disaster for any politician who voted for it.

    This is one reason why major legislation like this has to be passed in a bipartisan fashion.

    The ACA only works if millions of the uninsured sign up for insurance. Sadly, the’s no real incentive for the uninsured to sign up.

  2. It is true that the small number of people who previously bought their own insurance may see their plans cancelled or their rates change. The risk of cancellation and plan modification has always been a “feature” of the private individual market. What is different now under the ACA is that the plans must meet minimum coverage requirements, and some insurers are choosing to leave the market or increase rates. What is also different is that the people who are losing their old coverage because of these changes now have an alternative (buying coverage through the exchange) which they didn’t have before, and many of them will be able to do so with federal subsidies.
    It is also important to point out that we are talking about a small percentage of the population who are in this situation (about 5%). The rest of the population either has employer provided insurance, Medicare, Medicaid, veteran’s benefits or no insurance, and this doesn’t apply to any of them.
    I agree that bipartisan support would have been nice, and would have been particularly helpful now.
    I also agree that this part of the ACA is dependent on the uninsured buying insurance. I really don’t understand why you say there is no incentive to do so — insurance at subsidized rates is now available to many people who had no access to it before, and would have been available to even more if governors of many states had not decided to forgo Medicaid expansion in their states. Most of these people want insurance coverage. The real concern, as I stated, is potentially low participation among young healthy people who believe they don’t need insurance, and are willing to take a small penalty instead.
    Short of making the penalties for non-participation stronger, what would you suggest?

  3. Thankfully Mr. Henshaw is not against transparency. An economics grad from UNC, he provides a link to his website/blog: “The Plunge (Plunging Toward Gomorrah),” which contains a post titled “Blind Faith: Thy Name is the Affordable Care Act.” He starts by stating: “I haven’t written specifically about ObamaCare lately because at this point the only people defending it are religious fanatics.” He then goes on to define ACA advocates as individuals who value irrational faith way above reason, adding “…given how emotional liberals are about this issue, it seems that many are still convinced that health care access is a life and death issue.”
    As Mr. Henshaw’s blog makes plain, Justice is not a highly regarded ethical norm among GOP opponents of the ACA – even when the issue is financial access to medical care that ACTUALLY IS LIFE-OR-DEATH for many uninsured people in America. So far as religion and faith go – yes, social justice was important to the Hebrew prophets, to Jesus, to Mohamed, to St. Francis, to 18th-19thC evangelical reformers, to Martin Luther King Jr. and to the “religious fanatics” (like all recent popes, most notably Pope Francis) who still care about the health and welfare of the poor, the weak, the marginal.
    It’s worth recalling that the ORIGINAL judgment on Gomorrah (in the story in Genesis chapter 19) resulted from its inhabitants’ active contemptuous bullying and attack against town residents who had chosen to show hospitality to alien travelers, to “the other.” (No question about it, to extend such hospitality, Lot and his family must have been “religious fanatics” just like Uncle Abraham, the “father of faith,” and all the rest of his ilk.)

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