Even good intentions can go awry when proper thought and planning are not factored in. This is the lesson of Obamacare.
The Affordable Care Act, more widely known by the name of its author, has undergone numerous court challenges and revisions since it was passed in 2010.
Last Tuesday, two appeals courts issued opposing rulings concerning tax credits to buy insurance in the federal marketplace.
The U.S. Court of Appeals for the District of Columbia Circuit concluded in Halbig v. Burwell that the Obama administration stretched the law too far in extending the subsidies through the federal HealthCare.gov website.
The same day, Richmond, Va.-based 4th U.S. Circuit Court of Appeals reached the opposite conclusion about the same set of facts in a case called King v. Burwell. In a unanimous decision, the three-judge panel called extension of the health insurance tax credits a “permissible exercise” of a federal agency’s discretion in interpreting ambiguous legislative language.
Nationwide, 6.7 million people, 85 percent of those enrolled, are receiving advance premium tax credits for coverage. Of those, 70 percent (4.7 million people) are in the federal insurance marketplaces.
So far, only 14 states and the District of Columbia have established their own exchanges. The federal government has established exchanges in the remaining 36 states, in most cases without state assistance.
Much of that resistance, as in Georgia, is based on the idea that the law was passed by a straight party-line vote without bipartisan support.
The law’s problems are many, most stemming from the fact an issue as complex as health care coverage was slammed through Congress by one party too quickly without weighing its negative effects.
As House Democratic Majority Leader Nancy Pelosi so famously stated, “We have to pass the bill so you’ll find out what’s in it.” It comprised more than 11 million words, tens of thousands of pages, yet was made the law of the land without full consideration of its total impact.
As a result, the law has been amended several times on the fly. President Barack Obama moved the deadlines for both the personal and employer mandates. He has made up to two dozen such alterations, according to some counts.
Last week, the administration ruled that scofflaws who fail to buy health insurance this year could be fined up to $2,448 per person and $12,240 for a family of five.
This idea of changing the rules after the law is passed is why Congress filed a lawsuit recently against the president, accusing him of legislating from the Oval Office.
Whether such a charge is worthy of a lawsuit, it points out the law’s biggest concern: It wasn’t well thought-out before it was passed.
As mentioned, the good intentions were there. Most everyone agreed some degree of health insurance reform was needed to get more people signed up and try to control runaway health costs. There are many causes for the latter, some not within the reach of legislative repair. Advances in treatment and technology have raised costs in many instances. The threat of malpractice suits, and large awards from them, have jacked up physicians’ liability, with those costs passed on to consumers.
And let’s face it, Americans’ expectations of what their insurance will cover has changed as well. At one time, health insurance was used for catastrophic needs while routine doctor visits and most medicines were paid out of pocket. As insurance began to cover more wellness visits, the need to expand coverage has raised costs considerably.
All this is why health reform was a worthwhile goal for both parties, despite disagreements over how to proceed. Many Democrats then and now favor a single-payer system that basically puts everyone on Medicare, nationalizing care as many other nations have done.
Republicans, on the other hand, prefer a market-based approach that doesn’t turn the health industry into a government-supported behemoth.
Obamacare sought to split the difference, creating mandates and a health insurance exchange run by state and federal governments but administered by private companies.
It may have sounded good to its backers, but its implementation has been a hot mess. In addition to the changes made after it was passed, the website’s malfunction in the early days of signups last year led to frustration, and eventually sent the Health and Human Services secretary packing.
And as we enter the third national election since the law passed, candidates continue to use it as a key campaign issue even as federal courts disagree over its validity.
It’s true many more people have been able to sign up for insurance, which is a plus. But some of the law’s other promises have not been kept. The idea “if you like your insurance, you can keep it,” as the president said so often, turned out to be bogus when providers began canceling certain low-cost policies in favor of more expensive coverage many didn’t want. That led the White House to again step in to fix that bugaboo.
Some parts of the law are popular: ending denial of coverage for pre-existing conditions, portability between jobs and the ability to keep children on parents’ insurance plans to age 26. Yet each of those worthwhile elements could have been included in a bipartisan bill without the downsides of the final version.
Still, chances of the ACA being repealed are slim, dependent on a total Republican takeover of Congress and the White House in two years. That means the administration will continue to tinker with it while the courts shoot down or support parts of it.
Yet the best strategy would be for Congress to start over and work together to iron out unseen problems and pass an improved law everyone can live with.
And maybe this time, actually read the thing before they vote on it.