Affordable Care Act works, can be fixed to work better

By JOHN BURBANK

(Dec. 15, 2016) — I am a lucky person. My jaw is broken, but that is not why I am lucky. I have good health and dental insurance. So when my jaw was fractured last month, I didn’t have to worry about how I could afford to fix it. Sure, I will pay some significant cost-sharing, but it will not make me poor. And this final fact overrides all the inconveniences of having my teeth wired and banded so the jaw can heal. That’s why I am lucky.

Before the Affordable Care Act, millions of people in our state did have to worry about the cost of health care. If they had “pre-existing conditions” they were forced to get their coverage through the state’s high-risk pool, which was very expensive. If they had insurance, their premiums or their share of premiums went up and up every year. The deductibles and out-of-pocket costs went up as well.

If they didn’t have insurance, they lived in fear of being sick or getting hurt, or they simply played the odds and thought they could get by. Some did. Others didn’t. They were saddled tens of thousands of dollars of costs for their care. And the hospitals where they received emergency care accrued hundreds of millions of dollars in costs for uncompensated care.

The proportion of people without insurance in our state has fallen by 10% between 2010 and 2015. That’s means that about 700,000 people now have health coverage that they did not have before passage of the Affordable Care Act.

Our rate of uninsured is at an all-time low — 5.8% in 2015. It has fallen further since then. This is an equal opportunity benefit. The uninsured rate for whites fell 7.5% between 2013 and 2015. For blacks it fell 10.2%. For Hispanics it fell 13.2%. For Native Americans it fell 14.3%.

How did this happen? The Affordable Care Act enabled coverage of young adults under their parents’ employer-provided health insurance until age 26. The ACA disallowed insurance companies from denying coverage on the basis of pre-existing conditions.

The ACA expanded our AppleHealth coverage up the income ladder, so that all citizens with incomes below 138% of federal poverty level could get health coverage. (That’s $16,400 for a single person and $33,500 for a family of four.) The ACA created the individual health insurance exchange and enabled immediate tax credits for people with income up to 400% of the federal poverty level who purchased their coverage through the exchange. That comes out to subsidized coverage for individuals with income up to $47,500. The ACA created subsidies for out-of-pocket costs for people up to 250% of federal poverty level — $29,700 for a single person and $60,750 for a family of four.

Today, 1,838,000 people get their health coverage through Apple Health and another 173,000 get their coverage through the health benefit exchange. Apple Health now covers over 136,000 people in Snohomish County. The individual exchange covers another 16,500. So in Snohomish County, as is true for the entire state, one out of every four people get their health coverage through the Washington Benefit Exchange.

We all know the Affordable Care Act is not perfect.

Out-of-pocket costs can be up to $6,000 per person. When your income goes up from $16,000 to $20,000, you have to go from AppleHealth, with zero cost, into the exchange, which, even at that income, will cost you almost $1,000 for your share of the premium and up to $2,500 more if you get sick and need care. As your income further increases, your health care costs get more out of whack.

So, the Affordable Care Act could and should be improved. But it does work. Millions of people in our state alone have health coverage that they did not have before.

What we need to do now is to decrease health care costs and eliminate wasteful unnecessary care. That means driving down the costs of pharmaceuticals, hospitalization, and specialty care.

But that would mean taking on the “swamp” of special interests in Washington, D.C. Donald Trump and the Republican-controlled Congress swim in that swamp. They want to repeal the Affordable Care Act. They don’t have a replacement. That’s their plan for making America great again. But that’s not our America.

John Burbank is the executive director and founder of the Economic Opportunity Institute in Seattle. John can be reached at john@eoionline.org.