On the heels of the postman’s delivery of an estimated 1.4 million insurance cancelation notices, the Obama administration announced last week the 2017 rates for insurance policies sold on Obamacare exchanges. Predictably, the escalation in rates continues unabated.
As CNN.com reported, rates for 2017 will increase on average 22 percent, and as much as 116 percent in Arizona. CNBC.com highlighted the further cost increase consumers will face from higher deductibles: “[d]eductibles for individuals enrolled in the lowest-priced Obamacare health plans will average more than $6,000 in 2017.” Consumers also face fewer options. Seventy fewer companies are participating in the exchanges next year and approximately 21 percent of consumers will be limited to choosing plans from a sole insurance carrier.
With the public again facing the heartburn of fewer and more expensive choices in health insurance plans offered on the Obamacare exchanges, the “Affordable” Care Act is now front and center again. Since then, critics of Obamacare have been on their annual encore tour of the “I-told-you-so” choir.
Bre Payton already noted the hilarity of President Obama calling the recently revealed problems with Obamacare “bugs” while comparing them to a cell phone glitch. The president insisted you fix a snafu rather than return to the days of the rotary phone. Unless, of course, it starts on fire. Call me crazy, but breaking every promise made to enact the “Affordable” Care Act reeks of spontaneous combustion. There’s a name for a product that goes up in smoke—it’s called a lemon. You don’t fix a lemon, you junk it.
The Federalist’s Mary Katharine Ham exposed a further twist (of the knife?): Obamacare makes the prudent and responsible act of purchasing insurance for a healthy family foolhardy and unreasonable, at least in a purely economic sense. To hit the trifecta, Michelle Malkin shared her family’s continued Obamacare saga as they face their third cancelation in as many years.
Proponents of Obamacare took a bifurcated approach: First, as President Obama did, they stressed the law had some problems to fix, then pivoted to Republicans’ refusal to fix the law. Second, supporters of the “Affordable” Care Act stressed the popular aspects of the law, such as paying for pre-existing conditions and for adult children up to 26 years old. Of course, these popular aspects of Obamacare (along with the other coverage mandates) directly cause the increase in insurance rates, triggering the death spiral.
But there is yet another flaw in seeking to vindicate Obamacare by focusing on those with pre-existing conditions. Just as Obamacare injures the healthy, it also visits harm on those with pre-existing conditions. It does so in four ways.
1. Limited Access to Doctors
First, to manage costs, insurance policies on the Obamacare exchanges limit access to doctors and medical facilities. For the healthy, Obama’s broken “if-you-like-your-doctor, you-can-keep-your-doctor” promise is an inconvenience and a burden. But for those with chronic health conditions, the consequences are more significant.
Malkin makes this point in passing, noting that her family’s soon-to-be canceled plan is “nosebleed expensive, but provides us access to specialists not curtailed by bureaucratic gatekeepers. This has been important for us because several members of my family have required specialized care for chronic illnesses.”
For individuals with rare conditions or diseases, called orphan diseases, the impact is even more dire because a limited number of doctors and clinics specialize in those diseases. For instance, there are just about 120 approved cystic fibrosis centers throughout the United States to provide care for the approximate 30,000 individuals with this genetic disease. Many patients already must travel several hours to see their specialists. Some are now finding those doctors and clinics are off-limits, as these recent posts on a patient forum show.
These threads aptly illustrate that having health insurance does not equate to receiving health care.
2. Restrictions on Drug Coverage
The last thread above highlights another problem with Obamacare. Individuals with pre-existing conditions frequently require an artillery of prescription medications. Insurance companies (still) participating in the Obamacare exchanges defend against the high costs of covering those with pre-existing conditions by limiting coverage for certain prescription drugs or establishing higher co-insurance and co-pay percentages.
Limiting drug choices affects those with pre-existing conditions more frequently and more significantly than it does healthy individuals. A quick Google search shows the above concerns are not isolated.
Repeat: Health insurance does not equate to health care.
3. High Deductibles and Co-Pays
Exchange-based insurance companies also attempt to manage costs by offering policies with high deductibles and co-pays. Ham pointed out the irony here. Prior to Obamacare, she had a high-deductible plan that cost less than her current plan. President Obama referred to such plans as “junk.” But following Obamacare, Ham’s “individual deductible is more than two times the high deductible on [her] old ‘junk.’”
The rise in deductibles hits those with pre-existing conditions the hardest because they regularly incur $5,000 or more in annual medical expenses. Of course, those with pre-existing conditions who are able to afford the high out-of-pocket expenses benefit if they could not obtain insurance before Obamacare. Unfortunately, according to a survey by the Commonwealth Fund, 44 percent of the underinsured (i.e., those with high deductibles or out-of-pocket expenses compared to their income) forego needed medical care.
Hillary Clinton points to this survey to support her proposed “fixes” to the “Affordable” Care Act. She suggests sweetening the law by adding more freebies—requiring insurance companies to cover three sick visits a year with no out-of-pocket expenses. Clinton also wants to limit out-of-pocket costs for prescription medications to $250 per month. However, even the most ardent advocate of Obamacare recognizes that such measures will further increase already too high premiums, leading more to forego insurance.
Repeat again: health insurance does not equate to health care.
4. Loss of State High-Risk Pools
Finally, prior to Obamacare states addressed the inability of many with pre-existing conditions to obtain health insurance by providing high-risk pools. Insurance sold in these pools was funded by a “combination of state funds, enrollee premiums, and fees assessed on private health insurance carriers.”
However, following the passage of Obamacare, the number of state high-risk pools dwindled from 35 to 13, with many of the remaining pools closed to new applicants. Thus, many people with pre-existing conditions lost the availability of high-risk pools, leaving as their only option the high costs and limited choice Obamacare provides.
Admittedly, some individuals with pre-existing conditions benefit from Obamacare. But it is a pretty narrow group: those without access to employer-based health insurance who were within the estimated 20 percent of applicants denied private health insurance, who lived in one of the 15 states without a high-risk pool, and who can afford the high premiums and co-pays of policies offered on the Obamacare exchanges. It’s not quite the promised panacea for those with chronic health conditions!
It’s time for the proponents of Obamacare to recognize that there just isn’t enough sugar in the world to make the “Affordable” Care Act palatable. This lemon needs to be tossed.
Margot Cleveland is a lawyer, CPA, and adjunct professor for the University of Notre Dame. Cleveland can be reached via email at mobrien@nd.edu or on Twitter at @ProfMJCleveland.
