While the Trump administration recently asked the Supreme Court to terminate Obamacare, the House of Representatives responded by passing a bill allowing for an expansion of the health care program.
As the political arena heats up as the November elections approach and Republicans and Democrats battle over health care policy, experts are weighing in on both sides of the debate, highlighting the underlying need for reform.
“It has been a boon to certain health insurance companies,” Doug Badger, visiting fellow in domestic policy studies at The Heritage Foundation, told The Epoch Times in an email. “Six companies that have collected billions from the federal government in premium subsidies now control half the individual health insurance market.
“Ironically, House Democrats have passed a bill that will increase government handouts to the health insurance industry.”
Mark Farrah Associates has compiled data on six insurance companies: Centene, GuideWell, Kaiser Foundation, HCSC, Blue Shield of California, and Anthem. Badger points out that the data, which is based on insurance company filings with their state regulators, shows that these companies “in the aggregate, increased their market share from 30 percent to 50 percent” even as individual coverage dropped to 12.4 million in December 2019 from 16.7 million in December 2015.
Badger says Obamacare, passed in 2010 as the Affordable Care Act (ACA), has benefited those receiving subsidized coverage and those with preexisting conditions, but there are many caveats.
“Unfortunately, it has done so in a way that has priced health insurance out of the reach of millions of Americans and has forced many people with preexisting conditions into plans where they don’t have access to the best medical care,” said Badger.
The Center for American Progress (CAP), a think tank founded by former Hillary Clinton campaign manager John Podesta and funded by billionaire financier George Soros, opposes the repeal of Obamacare. It argues that terminating the program would deprive 23 million people of coverage.
“Repeal would eliminate essential consumer protections, including those for people with preexisting conditions; requirements for insurers to spend premium dollars on patient care; and mandates that insurers cover prescription drugs, mental health care, and other essential health benefits,” CAP said in a commentary on June 24.
The bill on June 29 was passed in a mostly party-line vote of 234 to 179 and aims to increase the subsidies for the ACA and add more federal funding for health care expansion. While the Republicans said they weren’t consulted on the “partisan” bill, Democrats said striking down the bill during the pandemic would be harmful.
“How can it be that at this very moment when the value of the ACA is so plainly obvious to tens of millions of Americans, that the administration is in court trying to strike it down?” Rep. Tom Malinowski (D-N.J.) said.
“This bill attempts to exploit the coronavirus pandemic to resuscitate tired, partisan proposals that would send hundreds of billions of dollars to insurance companies in order to paper over serious flaws in Obamacare.”
‘Americans Deserve More’
Experts have said Obamacare is not a perfect law—some say it should be repealed, others say it should be fixed. However, they all agreed on one point—the need for reform in the health care system.
“Congress repealed Obamacare’s tax penalty on the uninsured, and the administration has expanded health care choices for families and small businesses. The Trump administration also has granted waivers from federal mandates that have enabled states to make health insurance more affordable,” said Badger. “But Americans deserve more.”
According to Badger, who believes that the law should be repealed, medical costs under Obamacare are still very high, and patients are still subjected to surprise medical bills.
“Many seniors struggle with the high cost of prescription medicines, small businesses face rising health insurance premiums, and too many Americans find themselves enrolled in health coverage that limits their choice of doctors,” he said.
Alan Sager, director of Health Reform Program at the Boston University School of Public Health, told The Epoch Times that while Obamacare isn’t a “perfect law,” it’s a “valuable step forward” and “the best law that could be passed in 2010.”
Sager said the law’s main aim was to finance health insurance coverage for 20 to 25 million people—about 50 percent of the 46 million who were uninsured when it was passed.
“This was done mainly through Medicaid coverage improvements—by raising the income ceiling for Medicaid for adults up to 138 percent of the federal poverty level. Also, the subsidized individual mandate coverage through the marketplaces has been important for people with incomes higher than Medicaid. And also, the provision covering children under parents’ private health insurance up to age 26 protected 2–3 million people,” he said.
Sager said the main drawback of the ACA was the lack of cost controls and that this has been a persistent problem.
“We are not yet politically committed to containing health care costs—even though we have, by far, the most expensive health care among rich democracies while failing to cover all people or deliver the highest-quality care,” Sager said.
Reforming Federal Policy
Badger believes that Congress should reform federal policy to reduce costs, increase health care choices, and create a system that he said is more centered on patients and doctors and not on “government and insurance companies.”
Badger’s hope rests on the Health Care Choices Proposal that he believes can reset the course of failed health care reform by delivering lower prices and more health care choices. The Health Care Choices Proposal is a health care reform plan unveiled in June 2018 by the Health Policy Consensus Group, which offers principles and recommendations to lawmakers that guide their decisions on Medicare and prescription drugs.
“Endorsed by more than 100 conservative leaders, the proposal also would protect people with preexisting conditions, reduce insurance premiums by up to one-third, and put patients and doctors in control of their health care,” said Badger.
The Health Care Choices Proposal was released when Congress began to discuss improving and modernizing the Medicare program, and it advises changes to bring “competition and consumer choice” into the program, according to the Galen Institute that facilitates the work of the Health Policy Consensus group.
Sager said that talks about repealing and replacing Obamacare have been going on for years—there have been no attempts at a replacement, but there have been attempts at repealing.
In this tug of war, there have been over 70 attempts to repeal or modify Obamacare, according to a 3-year-old Newsweek report, and Sager said the bill passed by the Democrats in the house on June 29 “isn’t going anywhere in 2020 in the Senate.”
However, he said he believes that the American people are incrementalists, and they like steady, gradual progress. “The ACA could be greatly improved by boosting federal subsidies, for insurance, simplifying administration, and reducing out-of-pocket costs,” said Sager.
Unlike Badger, Sager doesn’t believe in the Health Care Choices Proposal, describing it as a “dream, not a reality.”
“The Health Care Choices Proposal is a fantasy because it imagines that effective free-market competition can actually be made to work in health care,” said Sager.
Sager believes that competition doesn’t help in improving efficiency, lower prices, or provide more choices in health care.
“What competition has actually done in recent decades is to spur mergers by hospitals—mergers that aim to boost their power when negotiating with insurance companies. And doctors are following suit. Government antitrust activities have usually been neutralized by political pressures from powerful hospitals,” Sager says.
He said the authorities should instead extend insurance coverage to all Americans.
“This can be done without increasing spending by one cent. The $4 trillion we are already spending on health … is enough to finance medical security for all Americans. That means effective, quick, and kind delivery of needed care, without plaguing sick people with co-pays or unaffordable bills when sick,” he said.
Meanwhile, while filing an appeal for Obamacare’s termination to the Supreme Court, Attorney General Ken Paxton of Texas, along with 17 attorneys general from Alabama, Arizona, Florida, and other states, said that Obamacare has failed and that states should be left to decide what kind of health care system they want.
“Obamacare has failed, and the sooner it is invalidated, the sooner each state can decide what type of health care system will best provide for those with preexisting conditions, which is the way the Founders intended,” Paxton said in a statement.