What Did Obamacare Get Right and Wrong?


US President Barack Obama speaks about the Affordable Care Act, also known as Obamacare, in the Rose Garden at the White House in Washington on April 1, 2014. Hundreds of thousands of Americans rushed to buy Obama's new health insurance plans on March 31, prompting a victory lap from a White House that paid a steep political price for its greatest achievement. The scramble to sign up under Obama's health care law at the end of a six-month enrollment window caused website glitches and long lines at on-the-spot enrollment centers. (Photo by: Nicholas Kamm/AFP/Getty Images)

Nicholas Kamm/AFP/Getty Images


Most people are aware their health care is considerably more complex than just seeing their medical bills paid for in full. There’s a number of costs, demands, stipulations, and a great deal of fine print that we’ve come to expect when talking about how much we spend on health care — and this hasn’t ceased to be the case with the installation of the Affordable Care Act.

It has changed, however, and with these changes come a degree of additional controls and requirements put in place. According to a breakdown of Obamacare’s various cost structures through Marketplace plans, there are positives and negatives under the president’s signature health care effort — and these are sometimes lost amid the controversy over basic principles and partisan gridlock.

As many know, a law usually isn’t all bad or all good; it’s a mix that requires tweaking and work. Let’s take a look at one of the advantages to the new system, and then pick apart what will likely be targeted as an ironic weakness.

Order and regulation in the face of chaos

For all its flaws, the Affordable Care Act did introduce a degree of organization into the health insurance structure with a number of rules governing cost and charges. For example, it made it mandatory that certain benefits be covered and that out-of-pocket expenses have a defined cap. There’s also a system of metal strata in medical plans with clearly defined actuarial values — meaning the amount of an individual’s medical expenses that are covered. These classes increase in expansiveness from bronze, silver, gold, and platinum.

There is also a catastrophic plan, which, alongside the bronze option, is the lowest price choice, and preferred by younger insurance shoppers — for example those newly past the age of 26 when parents’ plans are no longer applicable. However, they still retain great deal of variation and flexibility for the provider in how they structure their costs and coverage, because they can chose to place the greatest weight of fiscal demand on deductibles, cost sharing, co-pays, and so on.

This is helpful for both the company and for enrollees who can pick plans whose structures will better serve their needs with as minimal costs as possible, and the increased degree of clarity, categorization, and cost ranking allows patients to more easily compare the plans. This is on top of and apart from simply comparing the differences in price and coverage between PPO, HMO, EPO, and POS health care plans. Is the system perfect order? Is it completely approachable and understandable? Absolutely not. However, it does represent an improvement over past structure in ways.

Cost of mid-level plans

“Although the ACA originally called for out-of-pocket maximums to be lowered for enrollees with incomes between 250% and 400% of poverty, this was unable to be achieved in combination with the prescribed actuarial value requirements and was changed during the regulatory process,” reports Kaiser in an analysis of the new system. Basically, what this means is that mid-level plans that families might struggle to afford, but reach for, are not actually more affordable. It’s also significant because there are cost-sharing reductions that only poor to middle income individuals and families can receive, but these are only given to incomes between 100% and 250% of poverty, and they are only given to those who take the silver plan.

So it’s both a positive and a negative. It does help, but it only goes so far, and the system unintentionally works against itself in this regard. According to Forbes, the silver plan costs approximately $328 per month with an average deductible of $2,550, an average copay for primary care visits of $30 and a pharmacy coinsurance of 40%. This is for those without subsidization, which could include middle class families.

It’s also important to note that regardless of what plan, subsidization, or tax credits available, if one goes outside of the in-network providers, expenses can sky rocket, making it extremely limiting in some cases where one can seek and receive medical care and have insurance remain an affordable aid.

The complexity of the Marketplace, health insurance in general, and the breakdowns of how each system works means that there are a great number of unintended or unconsidered effects on costs when it comes to health care, and this is a legitimate and understandable critique of the system, and it’s why reform and quality monitoring, reviewing, and improving must be done systematically.

Follow Anthea Mitchell on Twitter @AntheaWSCS


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