What’s really happening to Obamacare


By Kelly Hawes

When the president says we should let Obamacare fail, what he’s talking about are the exchanges that provide health insurance for this nation’s working poor.

According to a report released by the Henry J. Kaiser Family Foundation, those exchanges provide insurance for about 7 percent of the U.S. population.

Most of the rest of us get our insurance through Medicare, Medicaid and private insurance provided by employers.

Even before the Affordable Care Act came along, the report said, many counties had limited choices for individuals seeking to buy health insurance on the private market. For this year, about a third of all counties had only one option for health insurance, and for the enrollment period that begins in November, many counties won’t have even that. They’ll have no companies participating in the exchanges.

That number includes four counties in Indiana — Decatur, Grant, Jackson and Wayne.

I sent an email to Jenifer Groth, director of communication and outreach for the Indiana Department of Insurance, asking about the outlook for those in need of insurance through the exchanges in those counties. She was succinct in her reply.

“The State is working to find the best course of action for those counties,” she wrote.

I asked if I might interview someone involved in that effort, and Groth declined.

“We will not speculate on what may or may not happen in the future,” she wrote.

The foundation’s report holds out hope that negotiations like those underway in Indiana will ultimately result in other insurers stepping in to fill the void left by companies pulling out of the exchanges. If that doesn’t happen, though, the report says the outlook is clear: people buying their own insurance in those counties will not be able to get subsidies and will thus have to pay full price for their policies.

The report insists that Obamacare is not on the verge of collapse.

“Rather, insurers are on track to be profitable and the market appears to be stabilizing in the country overall,” the report said.

What could change that, it said, would be for the Trump administration to stop enforcing or to weaken the individual mandate. Insurance companies say they need that mandate to get healthy people into the insurance pool, and without it, they say, they’ll be forced to raise premiums or get out of the market altogether.

Another thing the administration could do to force the Affordable Care Act over the cliff is to scale back on public outreach and on helping people to get signed up for the program. It could also stop making cost-sharing subsidy payments to insurance companies, a move the foundation estimates might boost premiums by 19 percent.

What Congress could do to strengthen the exchanges, the report said, would be to bring back a temporary reinsurance program that was phased out last year. Such a program would help insurance companies cover the cost of insuring individuals with expensive medical conditions.

The report also suggests giving states more flexibility as they seek to attract insurers to offer policies in rural areas.

The bottom line is that the Affordable Care Act is not collapsing. Much of the program is working exactly as it was designed to work, and the parts of the program that aren’t working can be fixed.

All it takes is the desire to do it.

Kelly Hawes is a columnist for CNHI newspapers.

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