New Orleans        Some twelve million people may have enrolled under the Affordable Care Act, but that doesn’t mean that Obamacare can catch a break.  Everywhere we turn there seems to be more potholes on the road.

Of course there’s the decision due in June by the Supreme Court on whether or not subsidies can be offered to the poor to enroll in the states where the federal government runs the marketplace.  Worse, dozens of current and former Congressman basically are saying that the four words that are in contention in this challenge were basically a “whoops, my bad” drafting mistake that was never part of debate or deliberation, but always assumed a “no brainer.”  Unfortunately that could still be enough to eviscerate health care coverage for lower income families in many states.

Now new studies and data are also pointing out the obvious problem with tax penalties not being effective in forcing enrollment when they come many months in the spring when taxes are due and long after the enrollment window has closed to gain coverage under the Act.  Interestingly, the lower income families seem more responsive to the penalties than those with more income hinting that the penalties might even be too low.

But, even past these almost technical problems, the concern we have often expressed that too much of the employer and marketplace coverage is simply too thin to cover the care is also becoming more obvious.   Too many people are woefully under-insured.

New estimates from the Commonwealth Fund Biennial Health Insurance Survey for 2014 found that 23 percent of 19 to 64 year-old adults who were insured all year – some 31 million people – had such high out-of-pocket costs or deductibles compared to their incomes that they were technically almost uninsured.  11 percent of privately insured adults had deductibles of $3000 or more in 2014, making any health insurance they might have, catastrophic at best.   The inability to limit deductibles is a huge crisis for lower income workers and their families with these low rider policies.

Normally, we could expect that what is broken could be fixed, but given the political season and the whooping and hollering that continues to be embedded in Congress in the far right efforts to deny healthcare to millions, there seem to be too many holes and not enough shovels.

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Go Ahead And Die! (Pirates Of The Health Care-ibean)  Music by Austin Lounge Lizards