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Last week’s vote by the House of Representatives to repeal President Obama’s health care plan was the 33rd such attempt – and just as unlikely to have any real effect as the previous 32 votes. In fact, repealing the entire law and replacing it with something completely different will be quite difficult politically. Nonetheless, over the long term, financial pressures are likely to force substantial alterations in the law as it currently stands. If those changes are made intelligently, they could lower costs and increase consumer choice, while preserving universal coverage.
Experts argue over every aspect of the Affordable Care Act, including its financial implications. But as even some of Obamacare’s greatest supporters admit, the goal was to craft a plan for universal health care coverage that could pass Congress and be signed into law. If there were flaws and awkward compromises, they could be fixed later. In my view, there are in fact two big flaws – Obamacare does not sufficiently control costs and its standards are too restrictive when it comes to determining what types of health care coverage are allowed. Both those flaws could be addressed by recognizing that the standards for catastrophic health coverage – protection against serious illnesses that are hideously expensive to treat – should be different from those for everyday medical expenses. Over the long term, I believe, financial realities and consumer preferences will encourage changes in just such a direction.
On paper, Obamacare has always been billed as a deficit reducer. But if you look solely at the part of the law concerned with health insurance, it adds more than $100 billion annually to federal spending, and that amount grows over time, according to the Congressional Budget Office. To prevent this from increasing the deficit, the cost is supposed to be more than offset by additional taxes and also by large cuts in Medicare spending. These proposed changes to Medicare are already meeting strong resistance from doctors and other health care providers.
Another part of the true cost of Obamacare is paid for by raising the income ceiling for Medicaid eligibility, and part of the cost of doing so would end up being funded by state governments. But the recent Supreme Court decision that upheld the constitutionality of the most important parts of Obamacare also included a provision that would make it easier for states to opt out of this Medicaid expansion, and some have talked about doing so. The CBO is preparing new projections, due out later this month, which will take this Supreme Court ruling into account. These new figures are expected to show higher long-term costs.
The bottom line is that there are multiple constituencies – especially in today’s financial climate of soaring government debt – who will press to reduce the costs of Obamacare and the policies meant to pay for it. At the same time, there is strong popular support for preserving certain parts of Obamacare. While it’s true that the number of people who oppose the law have always outnumbered those who favor it by around five percentage points, a sizable minority of around 40% have consistently supported it. Even more important, some specific provisions have always been generally popular, such as those that allow young people to stay on their parents’ insurance up to age 26 and those that prevent insurers from limiting or denying coverage.
Where HSAs are currently available, they have proved highly popular. The number of Americans with such plans has tripled since 2007 and grown 18% to 13.5 million over the past year. Yet current Obamacare rules greatly restrict the eligibility of plans that include HSAs – and this is only one example of the ways in which requirements that may be appropriate for catastrophic coverage unnecessarily restrict the options for plans that cover everyday medical expenses. Some people, for financial or other reasons, may prefer traditional health insurance. But there is no reason not to encourage as much flexibility and diversity as possible for non-catastrophic coverage, especially where doing so would reduce unnecessary administrative costs and increase consumer choice.
Read other related stories about this:
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Obamacare Repeal Not That Easy
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