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2016 Election Analysis - Part 5: The ACA

Category: Health Care
Posted: 12/09/16 16:40

by Dave Mindeman

The ACA became a major component of the 2016 campaign, both locally and nationally. It was the Republicans favorite thing to bash. To dismiss as unworkable. To pivot to when they got cornered on something else.

But the massive amount of disinformation that has been projected onto this law has been obscene.

Let's start at the beginning. Republicans called the ACA a government takeover of health care. That is incorrect. The Affordable Care Act only provided a marketplace for existing insurance carriers to participate in and made additional mandates that attempted to move this country to full coverage for everybody. These mandates have become the most popular provisions of the law: guarantees for pre-existing conditions, no coverage caps, children can stay on plan to age 26, women pay the same for coverage, and preventive care is free. The big objection was the mandate that forced everyone to get health care or pay a penalty. This mandate was necessary to make the coverage pool broad enough to make it affordable.

In order to get insurance carriers on board, the law made accomadations for them up and down the line. In addition, they tried to incorporate some Republican suggestions - which in the end didn't matter because they had decided that all of them had to vote against it.

So, the law launched without a public option (which would have solved many of its current issues) and with constant criticism and Republican tinkering. The GOP got control of the House later and wiped out the risk pool and our own Erik Paulsen wiped out a revenue source from the Medical Device industry.

Then the insurance carriers apparently went into the pricing of their products in this new environment and were completely unprepared. If you look at the history of the exchange in Minnesota you will see that the initial pricing on premiums was very low. Too low as it turned out because the insurance companies began complaining about losing money. Then they overcompensated and premiums skyrocketed.

In Minnesota's case regarding its Medicaid clients, it was put up for bids with the insurance carriers and Medica lowballed an offer that took UCare (which had done an excellent job) out of the running. Obviously, Medica had not analyzed this very well in their zeal to bring in all this new business and are now complaining about the losses that THEY PRICE INTO THE SYSTEM.

All of these insurance mistakes have conveniently been blamed on the ACA. Why? Because the Republicans insist on it. Bypassing the use of facts, they blame insurance losses on the ACA, they blame high premiums on the ACA, they blame Doctor networks on the ACA.

The ACA is only an exchange that manages a marketplace, directs people to the carrier they choose, and provides subsidies to those that qualify.

It DOES NOT set premiums, coverages, deductibles, and any of the other things that insurance companies have always done...prior to, during, and after the ACA came into being.

Now, insurance carriers are criticizing the ACA because, of course, they want the government to bail them out of their own mistaken stupidity.

The ACA cannot help the insurance companies to cope with universal coverage. The carriers need to analyze the marketplace and come up with fair value. That is their job, that is what they are supposed to do.

If they cannot do it - then single payer can take over and do it right.
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