Fixing And Improving The ACA Is A Winning Strategy

The Affordable Care Act or Obamacare will be ten years old next spring. Since the act was signed into law on March 23 2010, millions of Americans have become insured who would have previously been uninsured. But the act has been controversial and the Republican party has made repealing and replacing the ACA its top priority. But despite more than 60 votes in the House of Representatives to repeal the act and even with the election of Donald Trump on a promise to “repeal and replace” the act, it still stands.

However, despite all the attempts to repeal the ACA, it has become much more popular and the American public has adapted to the law. Despite Republican attempts to undermine the act, it is still working and insuring millions. But this is not to say that the ACA needs some improvement as well as a major overhaul to achieve its objective of insuring most Americans and reining in the high cost of health care.

In last month’s column, I said that embracing the idea of a government run single payer health insurance system covering everyone and everything would be a losing strategy for the Democratic party. Now I am saying that improving the ACA to make it work better would be a winning strategy. Here are some ways to improve the ACA that would lower premiums and cover more people.

Allow people between the ages of 55 and 64 to “buy into” Medicare. The amount of the “buy in” would depend on how many quarters of coverage paid into social security. But this would allow early retirees as well as older workers who are self employed or not covered through employer health insurance to get into Medicare. In addition this would improve the risk pool for the ACA exchanges since it would remove the oldest age group from the exchange risk pool. The result would be lower premiums for policies through the exchanges. This idea was on the 2016 Democratic party platform, but was lost in all the rhetoric of the campaign.

Establish the “public option” and make it the default selection for the exchanges. The idea of a “public option” health insurance plan supported by the government was originally in the initial draft of the ACA in 2009 but was taken out to gain more Republican support. However this idea has merit since it would offer an exchange plan available in every state and county in the country. Since many individuals refuse or just don’t voluntarily enroll in health insurance, mostly because they are young and healthy and do not see the need for health insurance; the “public option” would be the default choice and people who fail to make an election on their own would be placed in the public option by default and their premiums collected as a tax.

Fully fund the risk corridors. This is a little technical. But when the ACA exchanges were established and pre existing exclusions were eliminated, it was anticipated that more sick people would enroll than healthy people. This has happened and resulted in a high degree of “adverse selection” in the exchange plans. The risk corridors were a government plan and funds that would compensate the health insurance companies for higher then expected claims due to adverse selection. Congress has consistently failed to fund these risk corridors. The result has been many large companies exiting the exchanges and higher premiums for policies through the exchanges.

Reinstate the penalty and increase the penalty so being uninsured cost more than getting covered. Repealing the penalty or individual mandate that penalized individuals who refused to get covered even though eligible for health insurance through the exchanges was irresponsible politics at its worst. Now with no penalty, it is cheaper to be uninsured than to get covered. It has also increased the amount of adverse selection since most of the people who chose not to enroll were young and healthy who are needed to offset the older and sick. It has resulted in higher premiums for exchange policies. 

These four points could strengthen the ACA and make it work better. There are more, but space makes it impossible to outline them here. Suffice to say, these could have the greatest impact on the ACA. It could lower premiums as well as deductibles and make health insurance more affordable for most Americans. Unlike a single payer plan as espoused by several Democratic presidential candidates, the ACA is still the law of the land and it is popular. Make it work better. We can do it!

Lee Kamps

Lee has been working with Medicare, Medicaid and private health insurance since he began working at the Erie County Welfare Department in January 1973 where a major part of his job was determining eligibility for Medicaid. He went into the private insurance business in 1977 with Prudential Insurance Company and within a short time had become one of the company’s top sales agents. In 1982, he was promoted into management where he managed two field offices and as many as thirteen sales agents. After leaving Prudential in 1986, Lee decided to become more focused on health insurance and employee benefits. He has advised many local employers on how to have a more cost effective employee benefit program as well as conducted employee benefit meetings and enrollments for many area employers. The companies Lee has worked with ranged from small “mom and pop” businesses to local operations of large national companies. Lee received his B.S. degree from Kent State University where he has been active in the local alumni association. He has completed seven of the ten courses toward the Certified Employee Benefit Specialist designation. He has taught courses in employee benefits and insurance at Cleveland State University and local community colleges. In addition, Lee is an experienced and accomplished public speaker. He has been a member of Toastmasters International where he achieved the designation of “Able Toastmaster – Silver” in 1994. He has also served as a club president, Area Governor and District Public Relations Officer in Toastmasters as well as winning local speech contests. Lee has also been a member of the Greater Cleveland Growth Association’s Speaker’s Bureau where he was designated as one of the “official spokespeople for the Rock and Roll Hall of Fame” prior to the hall’s opening in 1995. He has given talks and presentations before many audiences including civic organizations, AARP chapters and many other community groups. With the implementation of the Medicare Modernization Act (Medicare drug bill) in 2006, Lee has shifted his focus to Medicare and helping Medicare beneficiaries navigate the often confusing array of choices and plans available. As an independent representative, Lee is not bound to any one specific company or plan, but he can offer a plan that suits an individual person’s needs and budget. In addition, Lee is well versed in the requirements and availability of various programs for assistance with Medicare part D as well as Medicaid. While he cannot make one eligible, he can assist in the process and steer one to where they may be able to receive assistance.

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Volume 11, Issue 10, Posted 7:57 AM, 10.03.2019