The proposed mergers of several big insurers continues to be a hot topic. Unfortunately, the poles of the debate are big insurance on one side and big providers on the other, leaving consumer interests on the sidelines no matter which behemoth wins this round. The typical anti-trust argument–more insurers means more competition means lower premiums means consumers win — is altogether too simplistic. Insurer mergers certainly could lead to higher premiums, but so too could an imbalance of power between payers and providers. More on this topic soon But, for now, the key takeaway is that to address the consumers need for quality, affordable health care, we need a broader frame than mergers–yes/no.
More Signs of Success and More Work to Do
New census data came out this week showing yet again that the ACA is reducing the numbers of uninsured Americans to historically low levels. A special round of thanks is owed to those who worked so hard for passage of the ACA, those who labored to get people enrolled and those who campaigned to undo the damage done by the Supreme Court by persuading state lawmakers to extend health insurance to the lowest income families.
While we can be proud of the success we have had to date, our work is far from over. Here are three key tasks in front of us:
- Closing the coverage gap in the remaining states. It is clear that the biggest coverage gains have come in states that implemented ALL of the ACA, including the provisions that make all citizens below 138 percent FPL eligible for Medicaid. Twenty states still have not taken this step and it remains a critical unfinished piece of the coverage agenda
- Making the enrollment process work for everyone. The enrollment process was much smoother during open enrollment two than it was the first time around, but there is still more that needs to be done to make the system work well. To cite just one example, it seems that many legal immigrants are getting caught up in a faulty eligibility verification process and losing access to premium tax credits that they are entitled to under the law.
- Making coverage and care more affordable. While the coverage gains to-date have been impressive, many who remain uninsured cite affordability as a continuing barrier. Some people who lack coverage are not eligible for premium tax credits, and many with coverage find out-of-pocket costs are still a problem. One welcome, though small, step to address the cost-sharing problem was a recently announced change in how family out-of-pocket maximums will be calculated so that the cost-sharing maximum for any person in a family plan can be no higher than the individual out-of-pocket maximum. Previously, the entire family out-of-pocket maximum could be applied to a single sick family member.
You’re Not Listening…
While high out-of-pocket costs are rising to the top of the American people’s concerns about health care, some political leaders have apparently not gotten the message. The House Republican leadership is continuing to press a lawsuit that would strip cost-sharing assistance from thousands of people and make it harder for them to access and afford medical care. That lawsuit got a recent boost when a judge in DC district court ruled that the House had standing to bring the suit. That ruling is likely to be appealed and ultimately overturned. Even if it were to prevail, it is not at all clear there would be any actual effect on people’s eligibility for cost-sharing reductions. What is more interesting is how the concerns of the American people are failing to register with the political leadership in Washington that is still committed to an anti-ACA agenda even though the rest of the country is moving on.
We have just finished the second Republican Presidential Primary debate (or debatathon in the case of this Wednesday’s five-hour extravaganza), and again, barely a word about the ACA. Seems like after repeated failures to upend the law and with millions of people now gaining coverage, there is less and less political mileage to be gained from ACA attacks (and “replace” seems as elusive as ever).