Monday, November 18, 2013

What is failure and what would that mean?

Josh Kraushaar:
Unless the website miraculously gets fixed by next month, there's a growing likelihood that over time, enough Democrats may join Republicans to decide to start over and scrap the whole complex health care enterprise.
What exactly would "start[ing] over and scrap[ping] the whole complex health care enterprise" look like? That's what I keep coming back to whenever I read about how Obamacare is threatened with failure. What exactly will failure look like?

As I said before, the ACA is a lot more than the web site. Most of the law is already in effect and seems to be working okay. That includes the largest part of the law (in terms of the number of people that it affects), the part that the media seems to have almost completely ignored: the revamping of regulations that govern private health insurance plans that are not purchased through the exchanges. Rescission, exclusions for preexisting conditions, and life time caps are all gone, plus there are a multitude of changes in coverage and the premium rates have been rejiggered.

Most of those changes are mandated by the new law. But some are not. Some of the changes in coverage and the premium rates were done by private companies in anticipation for the changed insurance marketplace under the Obamacare regime. What will happen if all those assumptions are suddenly removed? The entire private insurance market currently rests on the ACA. If you take that away, what will it look like on the other side? I don't think anyone has a clue, even moreso because the proponents of "repeal and replace" have proposed nothing substantively on the "replace" side.

Which brings up the bigger problem with the whole "Obamacare is failing!!!!" idea. The law is mostly failing on a political level. As a policy the law has one major problem: the federally-run web site isn't working very well. That means that enough people might not sign up for the law's changes to the individual market to work. Other than that, it seems to be working okay. (At least as far as I can tell. One problem is that a lot of the reporting on the issue seems to be written by people who have no idea that there is anything else in the law other than the web site to be used my the minority of people who need to buy an individual policy in 36 states). Plus, even if you are one of those individual marketplacers in the 36 states with a federally-run exchange, there are workarounds to the federal web site, like HealthSherpa.

The whole kerfuffle over the "if you like your plan, you can keep your plan" line is not a substantive problem with the law. It doesn't mean that the law itself isn't working. It just means that it was advertised to the public dishonestly. I don't understand why so many articles suggest that the President's political embarrassment for saying something that wasn't true has anything to do with whether a major regulatory change of the health insurance system is, in fact, delivering health coverage to more people at a more affordable price. Believe it or not, the success of a law that has already been enacted does not depend upon presidential approval numbers. But very few people are looking at the law on a substantive level outside of the portion that deals with the individual insurance market. The expansion of Medicaid alone has brought coverage to hundreds of thousands of people. That has gotten almost no coverage because medicaid helps the poors. From watching the news you would think the only thing Medicaid does is give governors the opportunity to make a political statement about the ACA by deciding not to expand it.