This week, the Republicans are feting their presidential and vice presidential nominees in Florida, and you can be sure there will be a healthy dose of Obamacare bashing. Candidate Mitt Romney has already pledged to repeal the Affordable Care Act if elected to the presidency. He won’t be able to do that without a complete Republican takeover of Congress, but there are plenty of ways he could eviscerate it nevertheless.
The Democrats will be re-nominating President Obama in North Carolina next, and rest assured the accolades for the ACA will be as lofty as the Republicans’ attitude toward the law is hostile. Still, two new reports about the effectiveness of the ACA should give the Democrats pause:
Confusing language in the health care reform law has raised the possibility that millions of Americans living on modest incomes may be unable to afford their employers’ family policies and yet fail to qualify for government subsidies to buy their own insurance. This is a bizarre development that undercuts the basic goal of health care reform — to expand the number of insured people and make their coverage affordable.
Even if the GOP doesn’t succeed in repealing the ACA, the law could start unraveling anyway. Thirty million people will remain uninsured after the ACA completely takes effect in 2014, and the law’s cost controls are inadequate. Meanwhile in Massachusetts, the ancestral home of the ACA, costs have still been spiraling out of control since that state’s own health reform law passed six years ago. Gov. Deval Patrick recently had to salvage reform by signing legislation replacing fee-for-service with a global payments system. Doing away with fee-for-service is a good thing, but I don’t think this move will be enough in the long run. After all, the Massachusetts law, like the ACA, unwisely continues to rely on profit-seeking insurance companies as an integral part of its health system. Insurance companies will still try to find ways to wring more money out of the pockets of the people and into those of overpaid CEOs and shareholders. They will continue to waste dollars on advertising and needless paperwork – dollars that should go into care. Massachusetts is the health reform canary in the coal mine.
If the ACA starts falling apart in the next few years – which is quite possible given its flaws – the United States will be forced to rethink the folly of sticking with free-market health care. The profit-seeking model only serves itself, not the people, because that’s what it’s supposed to do. Instead, we need a healthcare system that serves the people, and only the people. The only logical solution is to improve upon and expand the public health insurance model to everyone, whether through SB 810 in California, or Medicare nationwide.