A fine gentleman called the paper recently to ask a seemingly simple (but really very complicated) question: What is Obamacare?
The caller voted in November for President Donald Trump. He said he is now wary of what that decision will mean for health care, especially for folks here in Lorain County.
Because it’s so politicized, any discussion of national health care has to start with perception.
A February poll by Pew Research showed 54 percent of Americans approve of the Patient Protection and Affordable Care Act — the actual Congressional name for Obamacare — while 43 percent disapprove.
The poll noted that 54 percent is a record approval rating since passage of the 2010 act. Obamacare/the ACA historically has tended to draw more negative opinions than positive, with a 48-47 percent split as recently as December.
Another poll last month, this time by Morning Consult, put a spotlight on how confused people are about the health bill. It found 35 percent of Americans don’t understand Obamacare and the ACA are the same thing.
That was evident when Sarah Kliff, senior editor for Vox, traveled to Whitley County, Ky., to talk to people about their health care. In the rural county, 82 percent of voters supported Trump; interestingly, the county saw a 60 percent drop in the number of uninsured residents since the roll-out of Obamacare.
Kliff wrote that she found Trump voters terrified of losing their health coverage.
Among them was Debbie Mills, whose husband is on a liver transplant list. The family is insured through Obamacare and hopes a much-touted plan by Congress and the president to repeal the ACA is stopped.
“I don’t know what we’ll do if it does go away,” Mills told Kliff. “I guess I thought that, you know, (Trump) would not do this. That they would not do this, would not take the insurance away. Knowing that it’s affecting so many people’s lives. I mean, what are you to do then if you cannot… purchase, cannot pay for the insurance?”
Everyone wants to be healthy. No one wants to be financially ruined by huge hospital bills. We all want a sense of security, to know that we can get medical help affordably when we need it.
But this is an issue with so much spin, misinformation, political baggage, and general confusion that most people (I think) don’t understand it at all.
And that leads us back to my caller’s question: What is Obamacare? And furthermore, how does it compare to what the president wants to replace it with?
Those are some weighty ones to answer, and there’s a lot of info to parse.
I’m not an expert by any means, but as a journalist I’m paid to learn what I can and pass it on to you. So here goes:
• The ACA is Medicaid that’s available to more people.
• You know Medicaid. It’s been around since 1965 and provides money to states to help provide medical treatment to residents, including those who struggle financially, pregnant women, special education students, people with disabilities, and older folks.
• The ACA was designed to increase health insurance affordability by extending Medicaid coverage to just about everybody.
• How? Through mandates, subsidies, and insurance exchanges.
• The “individual mandate” requires almost everybody to have a minimum level of health insurance (there are some exceptions, such as people who live in extreme poverty, living overseas, nonresidents, American Indians, the Amish, etc.).
• That insurance can come from your employer, a privately purchased plan, or government programs.
• You can also choose to pay a “shared responsibility payment” (let’s not mince words… it’s a fine) to opt out of insurance coverage.
• Subsidies are available to households with incomes of 100 to 400 percent of the federal poverty level. They’re basically tax credits the government will give you to help pay for insurance.
• For example, a family of four that makes $44,100 per year can pay $2,778 in out-of-pocket premiums and get a $4,000 subsidy toward health insurance costs, saving $8,366 on premiums.
• The ACA also established health insurance exchanges or “marketplace” — mostly online stores such as Healthcare.gov where you can shop for insurance plans.
• Private companies such as AultCare, Buckeye Community Health Plan, Humana Health, and Summa Insurance actually offer the coverage, which has been negotiated by the government but isn’t actually provided by the government.
• There are a number of packages (bronze, silver, gold, platinum) that, depending on how much you want to pay monthly, will cover from 60 to 90 percent of your health care bills.
• If you’re under 30 and just want catastrophic coverage, you can pay a ton for the most stripped-down plan.
• A major hallmark of the ACA is a requirement that insurers cover people with pre-existing conditions. That means you couldn’t be denied coverage because you have diabetes, cancer, asthma, or other diagnoses.
• It also bans insurers from dropping policyholders who get sick.
• Medical screenings, vaccinations, and preventative care aren’t subject to co-payments, deductibles, or co-insurance under the ACA. That affects everything from getting tested for diabetes to getting a mammogram, being counseled for domestic violence, getting breastfeeding support, getting a colonoscopy, and more.
• Obamacare bears many similarities to what former Republican presidential candidate and Massachusetts Gov. Mitt Romney signed in his state in 2006. “Romneycare” expanded Medicaid through an individual mandate, tax credits, and an investment income tax increase for the richest residents.
• There’s an enrollment period each year during which you can sign up (it’s closed now).
• More than 20 million people are now covered by the ACA.
• That includes roughly 12.7 million people who, as of February, signed up in the marketplace.
• In 2016, the uninsured rate fell to an all-time low at 8.6 percent of Americans (that’s 26.6 million people) ages zero to 65. Before the ACA was passed by Congress, the uninsured rate was 15.7 percent (48.6 million people).
• Three quarters of customers were eligible for plans costing less than $100 per month in 2016.
• About 85 percent of customers qualified for financial aid in the form of tax credits.
• Several insurers cut back their presence on the marketplace for 2017 plans, including giants such as Aetna and Cigna.
• At the same time, the cost of many plans rose dramatically during the most recent enrollment period, mainly because insurance companies underestimated costs when bidding on ACA contracts in 2014.
• Trumpcare, which has not yet been adopted, is the president’s proposal for replacing the ACA.
• Its actual name is the American Health Care Act, or AHCA (I’m going to refer to it as Trumpcare because ACA and AHCA could be easily confused).
• It calls for measures that would slow (not reduce) the federal deficit’s growth by $337 billion over the next decade.
• The Congressional Budget Office released an estimate March 13 indicating more than 24 million Americans would lose their health insurance coverage through 2026 under Trumpcare.
• That would bring the total number of America’s uninsured to 52 million (nearly 15 percent of people) in the coming decade.
• Trumpcare calls for more emphasis on insurance assistance through refundable tax credits.
• Insurance tax credits would be capped, which means more in premiums for older people.
• The CBO projects insurance premiums would rise under the president’s plan by 15 to 20 percent through 2020, then begin to lower, ending with premiums at 10 percent less cost on average by 2026.
• Older Americans would pay more for insurance under Trumpcare, which would allow carriers to charge them five times more per month than younger Americans (insurers are allowed to charge three times more to older people under Obamacare).
• Trumpcare would also cut “regular” Medicaid funding by $900 billion.
• There would be no fine for going without health insurance.
• Trumpcare would still include provisions for people with pre-existing conditions.
• It’s actually a $600 billion tax cut through 2026. The nation’s wealthiest people (the top 0.1 percent of us, which does not include me) would each get a $200,000 break, according to the Joint Committee on Taxation.
• The largest slice of that tax cut is through repeal of Obamacare’s 3.8 percent investment income tax.
• Conservative news outlets have condemned Trumpcare as “Obamacare 2.0” and “Obamacare Lite,” saying it doesn’t go far enough to get rid of government’s involvement in health care.
• Repeal of Obamacare is expected to increase budget deficits over the next decade by $137 billion to $353 billion (the difference relies on whether you consider macroeconomic feedback, which means the effect on interest rates, GDP, and other economic ripples).
• The CBO says repealing Obamacare would increase tax revenue by raising economic input, but would cost more in the long run because more people would be uninsured and need assistance.
Those are the bare facts.
And it’s where I’ll stop, lacking several more drums of ink and 20 more hours to do research.
There’s plenty of ground I don’t have time or space to cover: How Obamacare has been upheld by the U.S. Supreme Court overall, though certain provisions were struck down. How economists argue over whether it’s had a positive or adverse affect on privately-purchase premiums. How Trumpcare isn’t drawing positive reviews from even conservative pundits. How many Republican legislators are nervous about an Obamacare repeal hurting their senior citizen base. Trump’s tweet that Obamacare is in a “death spiral,” and assertions by the CBO that it’s stable. Disputes over the true costs of both health care models. The unintended consequences on small businesses. The debate over whether health care is a basic human right.
For now, I’ll simply leave you with my best wishes for your health.
Sources: Congressional Budget Office, Joint Committee on Taxation, Committee for a Responsible Federal Budget, U.S. Department of Health and Human Services, Trumpcare.com, Healthcare.gov, Medicaid.gov, The New York Times, Forbes, National Review Online, Vox, CNBC, CNN Money, Pew Research, Gallup, Morning Consult, RAND Corporation, U.S. Census Bureau, American Public Health Association, The National Law Review, Centers for Medicaid and Medicare Services, Centers for Disease Control and Prevention, Breitbart, PolitiFact, public statements by President Donald Trump and Speaker of the House Paul Ryan