Affordable Care is Simply Not Affordable

HealthCareGovSiteNew Orleans    The more studies that are done, the more time that passes, the more it seems impossible to get around the core issue embedded in the compromises of the Affordable Care Act: it’s just not affordable for lower income families.

The government’s projections for the current signup period are frankly modest at about nine million signups, rather than the twenty million projected several years ago for this period. Given the number of states that continue to boycott the expansion of Medicaid, which is where a lot of the gap for the uninsured continues, the budget offices are finding the predicted costs of Obamacare are about 20% lower than originally expected.

Furthermore, the mandate is not pushing enough people into insurance who don’t have it, particularly among lower waged workers. Studies are finding that at about $40,000 the maximum participation is achieved. Lower income families are simply paying the penalty, because it’s cheaper than the insurance bite.

Reports from employers are very depressing, though not surprising. Having represented big health care employers with sorry health plans for decades and seen the abysmal participation figures, we were hardly shocked, but still reading figures for huge food service companies with tens of thousands of employees and their reports of only 500 workers out of 25,000 actually signing up for employer insurance is ridiculous. The workers are blocked from access to ACA marketplace subsidies and cost sharing because they have opted out of corporate insurance, but they have opted out because the costs are too high and the benefits are too crummy with essentially catastrophic coverage and deductibles as high as $6000. Who can afford any of that on $10 or $15 per hour?

Increasingly, it seems clear we have a little bit of something for health insurance, but it’s only a bit better than nothing, and under the private company and corporate-centered regime, it’s too pricey and too paltry. We need real national health insurance, but that means a more significant governmental investment, and that is a bridge way past the level of political consensus.

It is also way past the level of public support, which fuels the continued opposition to Obamacare. When even the primary beneficiaries of the program among low-and-moderate income families are still priced out of the market, who is left to show the program the love it needs and deserves?

Half-stepping clearly has only gotten us halfway to where we need to be. We shouldn’t be surprised, but that doesn’t make it any easier to live with the disappointment or the continued perilous state of national health protection in the United States for low-and-moderate income families.

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Arkansas Health Care Battleground Focuses on Stopping Enrollment

Toney Orr, Local 100, speaking in support of private option at the Arkansas Capital.

Toney Orr, Local 100, speaking in support of private option at the Arkansas Capital.

Little Rock  The so-called unique “private option” in Arkansas where a federal Affordable Care Act waiver allows federal money to purchase insurance from private companies for low-income families continues to be a year-by-year battleground.  Importantly this program along with Medicaid expansion, both navigated by Democratic Governor Mike Beebe through a Republican legislature, has already allowed 100,000 people to gain insurance.  Earlier this week on a 5th vote by the Arkansas House another year’s extension was approved by a supermajority vote of 76-24, finally fulfilling a commitment from the Republican speaker that they would keep voting until the measure passed since not doing so would open up a $90 million budget hole.

            There were prices paid for the extra votes, and most of them were blatant agreements to discourage any effort by the state and its Insurance Commission to increase enrollment in the program, joining Texas and other state in aggressive attacks against navigators and other assistors.  An amendment to the bill, enabling its final passage, expressly forbade any further expenditures by the Insurance Commission through advertising or outreach to increase participation in Obamacare.  This is not conjecture.  Here is the description from the conservative National Journal:

One of the main amendments, written by Republican state Rep. Nate Bell, prohibits any state funds from going toward promotion or outreach of the ACA in the state. This includes enrollment in the private option, as well as the overall exchange. Bell—an unabashed critic of the private option and the health care law—has said he ultimately wants the program to fail, and that this amendment is intended to stymie enrollment.  “I believe it’s important as a conservative that we recognize the situation we’re in,” he said on the House floor during an earlier vote last month. “When we can defeat bad policy, we should do so. When we can’t defeat bad policy, it’s our responsibility to do everything we can to influence it and make it as closely aligned with our philosophy and policy as we can.”

            By July 1st 600 consumer assistors around the state of Arkansas will be laid off due to the amendment.  Calls from the Insurance Commission staff to navigators have already begun, begging for help, but Congress in initially funding the HHS navigator program only funded the work for one year, ending August 15th, so the notion that six to ten health care organizers can pick up the slack for six hundred is absurd, not even considering the fact that navigators obviously work under the direction of the Center for Medicaid Services of HHS and not a state agency. 

What a mess, and worst, similar to every other state, huge numbers remain to be enrolled, and no matter the Obamacare-hate, it’s the number of new health care participants who are in fact saving the program.  The Arkansas Democrat-Gazette caught this clearly in interviews with some of the vote switchers who saved the bill:

Rep. Kim Hammer, R-Benton, announced he would vote for the bill after previously opposing it. “There are people who will be hurt if I don’t vote for this,” Hammer said. “And I don’t want to see those innocent people hurt because of that.”  Hammer — who joined Reps. Les “Skip” Carnine and Mary Lou Slinkard in switching to yes votes — said he had not “betrayed” opponents of the bill and would not shy from voting against it next year if the program is not successful. “I haven’t stepped away from it,” he said. “I plan on coming back in January. And it better be successful. Otherwise it will be voted down.”

This is a battleground where we can’t win unless we are on the field, but both the stakes and the measures of victory are crystal clear.  We don’t win and keep affordable healthcare and coverage for hundreds of thousands of lower income families in Arkansas unless there is a robust and aggressive enrollment program, beating the bushes and bringing people under coverage.  The opposition understands this, but the days are now being numbered on how long navigators and others can be kept on the streets.

Talk about being asked to fight with our hands tied behind our backs!

 

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