What Healthcare Reform?

During the debate over the Affordable Care Act, popularly labeled Obamacare, supporters were quick to label it legislation to “reform” healthcare. While that claim was echoed by Congressional Democrats, social justice advocates, and swooning media types, the law is primarily a federalized composite of the system it replaced. The new law also federalized the same flaws that dogged the old system.

The bulk of new enrollees come through expansion of two existing programs, Medicaid and the Children’s Health Insurance Program. In addition, young adults are now allowed to remain on their parents’ plan until age 26. While the social justice crowd praised the Medicaid expansion, it conveniently avoided concerns re the quality of care Medicaid recipients receive. Restrictions on access to care under Medicaid, especially in finding specialists that accept those covered under the program, have resulted in Medicaid patients suffering worse outcomes, on average, than patients merely showing up at the ER when sick or injured.

The law sets minimum requirements for policies written in the United States, replacing those established by individual state insurance commissions. Since the federal minimums exceeded those set by some state mandates, lots of folks found their old policies canceled, while the federalized policies that replaced them delivered sticker shock in the form of higher premiums, higher deductibles/co-pays, or both. A major flaw in the original, state-regulated system was the inability to buy a policy across state lines. People willing to accept lesser coverage for cheaper premiums were unable to buy a policy from a state with fewer mandates. The new, federalized minimum means that only a select few get the option of a bare-bones, low cost plan. The ACA is one place where “choice” is not an option.

There are a couple of new wrinkles thrown in, prohibiting insurers from denying coverage for pre-existing conditions, and penalizing insurers who spend too large a percentage of the premiums they collect on administrative costs. Hailed as a slap at “cold-hearted” insurance executives, denying an insurer the ability to assess for risk gives insurers an incentive to avoid covering patients in poor health, or suffering from a chronic condition. Cutting administrative costs will be nearly impossible, since the ACA imposes huge new reporting requirements on doctors and hospitals. Higher costs for premiums, diagnosis, and treatment will be employed to balance the expense of the additional reporting requirements imposed by the law.

Even if one accepts the premise that the legislation is a genuine reform of the previous system, the real misnomer is that the Affordable Care Act is not about health care at all, but rather health insurance. In fact, the law, for all its 2000 pages, adds not a single new doctor, nurse practitioner, or physician’s assistant.