With the Democratic National Convention starting today in Chicago, we can expect a lot of talk this week – and right up until we vote on November 5 – about the Affordable Care Act, or “Obamacare” as Republicans and their allies have called it from day one.
Expect to be hit with a firehose of misinformation. Probably no other bill has ever been so praised and maligned. You know by now that most Democrats are very proud of it, despite its misses and shortcomings. You also know that most Republicans, certainly Donald Trump, have tried repeatedly to repeal it. They came one vote short of doing that during the early days of the Trump administration. It would have been long gone had Sen. John McCain (R-Arizona) not joined Democrats in voting against repeal in 2017.
The former prisoner of war was 80 at the time and had recently been diagnosed with brain cancer, but he flew from his home in Arizona to cast the deciding vote. Democrats applauded when he announced his “no” vote. Republicans gasped. Trump called him a loser and said he had more respect for people who had avoided being shot down and tortured for six years in a North Vietnamese prison.
There’s a good chance President Biden will mention the ACA in his speech tonight at the DNC. After all, moments before then-President Obama signed the bill into law on March 23, 2010, Biden famously whispered to Obama, “This is a big f*cking deal.”
And it was. Democrats had tried for decades to pass sweeping health care reform, and the ACA was a culmination of their efforts. It’s important to note that many progressives were just as mad about the ACA as Republicans were but for different reasons. Some of them were so upset during the final days of the debate (because it didn’t establish a single-payer system) that they shouted “Kill the bill!” in protests around the Capitol and across the country.
For his part, Trump wants to give repeal another go, and he’s still pissed at McCain, who died soon after that historic vote. Many of Trump’s supporters (and allies of Big Insurance like Sally Pipes of the Pacific Research Institute), are on board with Trump and are back at work trashing Obamacare. (The Pacific Research Institute is one of the numerous right-wing organizations that worked with the Heritage Foundation to produce the now-infamous Project 2025.)
As a former Big Insurance propagandist who helped plan the effort to keep the ACA from being enacted (and who switched teams and became a whistleblower in 2009), I know all too well what life was like for millions of Americans before the law was passed and what it would be like for even more of us if Trump gets another chance to deep-six it.
Pipes, who sees eye to eye with me on one thing, and maybe one thing only – the need to reign in greedy Big Insurance-owned pharmacy benefits managers – took to the conservative Washington Examiner last month with a recycled attack on the ACA. As I read it, though, I was struck by how effectively she had laid out some of the biggest reasons why the ACA should not be repealed. Admittedly, this is out of context, but this is what she wrote:
Insurers must cover every applicant, regardless of health status or history. They can only vary premiums according to age, geography, and tobacco usage.
In other words, people with significant health risks pay the same as those who are in good health. And insurers may not charge older beneficiaries more than three times what they charge younger ones, even though the costs of older patients’ claims can be roughly five times higher.
Obamacare must also cover 10 “essential health benefits,” including substance abuse services for people who don’t take drugs.
That’s all true, and, in my book, a good thing.
In the days ahead, my colleague Joey Rettino and I will delve into those “awful” constraints on Big Insurance and other ACA-related issues in greater depth. We decided to do this because we humans have poor memories. Many of us have forgotten what the “good old days” before the ACA were really like. And a large percentage of voting-age Americans were not old enough to vote back in 2010 – and certainly not old enough to have to worry too much about health insurance.
We’ll also address the shortcomings I mentioned earlier, and some of the unintended consequences of the law (although apparently not unintended to people like Peter Orszag, considered one of the “architects” of the ACA. As STAT’s Bob Herman noted in his newsletter today, Orszag couldn’t be happier that Big Insurance has grown vastly bigger since Obama signed that BFD into law.)
We’ll also fact-check the BS that’s about to be hurled your way in the coming months. So stay tuned.
I guess I'm the only contrarian here. Here are the facts about the ACA:
- It wasn't necessary to redesign health insurance. Also, the "Metal" Levels just created confusion. Today, plans that are labeled "Gold" look and feel like "Silver" plans. This just increased the cost of health insurance.
- The Summary of Benefits and Coverage requirement is confusing at best.
- Age weighted premiums for small group health plans. For an average plan, the premium for a 60 year old is 3 times that of a 30 year old. All other things being equal, employers would be incentivized to hire younger workers over older ones for those who have the same qualifications.
- The law could have been written to do only 2 things: a.) provide an online portal where individuals would register, input their info and receive a determination on how much of a subsidy they would qualify for. The portal would then provide a control number in which they would provide to the health insurer to apply the subsidy to the premium. b.) that all policies are guarantee issue.
- With respect to the Marketplace, the government spent $30 billion for a website that crashed and was prone to hacking. Jeff Bezos offered to create the portal for 1/10th that amount.
- Its popularity stems from the fact that people like free stuff. Take away the subsidies and popularity plumets.
- The original legislation didn't contain cost sharing subsidies to Silver level plans. This was added by the Obama Admin through HHS and subsequently declared unconstitutional. The Administration asked insurers to provide the cost sharing subsidies and they complied, adding about 18% premium for Marketplace over non-Marketplace Silver level plans.
- Today, many, who do not qualify for a premium subsidy, go to the Marketplace and purchase a Silver plan, not knowing the same plan off Marketplace is 18% cheaper.
- Obama sold the ACA by claiming families would save $2,500, and would be able to keep existing plan and their doctors. The reality, the cost for a family increased by more than $2,500 per year in the 3rd year. Many doctors were not in the narrow provider networks. Although many insurers allowed their subscribers to keep their plan for a few years, they forced everyone with individual plans into ACA plans. Blue Cross Blue Shield of MI informed both individual subscribers and small group clients they would be forced into ACA plans no later than January 1, 2014. They were the only health insurer in Michigan to do so.
- With the advent of the ACA, there are now fewer than a handful of health insurers in each state. Prior to the ACA, Michigan had no fewer than 30 health insurers. Today there are only 5 health insurers that offer fully insured plans.
- The ACA has resulted in consolidation of health care providers. The distortions include dominant hospital systems through the purchase of individual medical practices and other hospitals in metropolitan areas around the country. Health insurers, like UHC, are now the biggest employer of doctors.
- Medical Loss Ratio - requiring health insurers to pay out in claims 20% of collected premiums. This created the above distortion. It's similar to the government telling businesses what their profit margin will be. Harris just outlined this in a recent speech about all businesses.
I could go on and on. This was all predicted BEFORE passage of the ACA. When the ACA was passed it was a shell. That's why Nancy Pelosi said "we have to pass it to see what's in it". The American public didn't see what was in it for another 3 years, with the final language appearing in 2013. Other than guarantee issue and premium/cost sharing subsidies, the ACA is a train wreck!
Be a Hero has been working for several years to realize Ady Barkan's dream of quality health care for everyone on the road to Medicare for All. We have been trying to teach people about these Medicare Avantage plans that the insurance cmpanies market so heavily. They are taking trillions every year from the Medicare Trust Fund to ostensibly treat people, then refuse their authorizations for care ("Deny") , delay care unnceessarily ("Delay"), and refuse to pay the hospitals, driving them out of business ("Don't pay"). They also kill about 10,000 [people a year while making their execs into billionaires on our Medicare tax dollars. To learn more, go to info@beaherofund.org and join our campaign to Reclaim Medicare fromCorporate Greed.