N
ow that the Supreme Court has once again saved Obamacare, can we have an honest talk about it?
Let me explain. On one side—you don’t need me to spell out which—the Affordable Care Act was demonized. It was going to bankrupt the health care system; destroy the United States’ reputation for excellent service; steal you away from your doctor; and, by some means never quite explained, lead us straight to communism. Today, subsidized health care premiums and an end to pre-existing condition exclusions; tomorrow, Stalin and FEMA detention camps located in semisecret parts of Texas. You know how it goes.
Under this assault, all too many ACA defenders turned into fanboys and fangirls, dismissing any issue raised against the law as inconsequential and exaggerated. And besides, it’s not like legislation to improve any aspect of it would get through our paralyzed, polarized, and now Republican-run Congress anyway.
But this strategy might well come back to bite the Democrats. The bill for the health care expansion is coming due, just as the recipients will be heading to the ballot box to vote in the first primaries for the 2016 election. More than a few are likely to be annoyed.
Last week Oregon’s insurance commissioner, Laura Cali, announced that the state had approved a 25 percent premium increase for the largest health insurer on the state’s exchanges. The second largest insurer did even better: It received permission to boost its monthly charge to consumers by 33 percent.
Oregon might be the first health insurance exchange equivalent of a penguin getting shoved off an ice floe, but it won’t be alone in the freezing-cold waters for long. For example, BlueCross BlueShield of Tennessee requested an average 36 percent price increase for the plans it offers—after receiving a 19 percent bump last year. And that sounds like a relative bargain compared with Minnesota and New Mexico, where the BlueCross BlueShield family is looking for increases of more than 50 percent. Even if the final numbers are lower than the asks, it seems quite likely these states will approve substantive premium increases.
The problem is simple. As Trudy Lieberman reported this month in Harper’s, the ACA made a decent stab at solving the problem of Americans lacking insurance. Unfortunately, the bargain struck to get the bill to a point where lobbyists for the hospital, insurance, and pharmaceutical industries to sign on, or at least not fight it, did not adequately address the issue of overall medical costs.
And that’s where the consumer comes in. Someone is “it,” the party paying the bill. And that “it” is increasingly you, whether you receive insurance on the exchanges or from an employer.
