I live in New York State, as many of you know. Last year the cost of my health insurance declined in the first year the exchanges became operative by $200 a month. In year two of the exchanges, my premium have gone down again by approximately another $200. That’s the good news. The bad news is my son, currently covered by my policy will drop off when he turns 26 in the Spring of 2015. However, it looks like he will be eligible for Medicaid (fortunately) because New York, unlike some states, did not opt out of the Medicaid expansion. He and I go to see a Health Care Navigator next week to take care of the details.
Unlike last year, I did look at silver plans on New York’s exchange exchange, some of which might have saved us an additional $200 a month in premiums, but none of them provided the same level of care, and all had a higher deductibles, than our current plan. In the end, it made sense to keep the coverage we had.
Unfortunately, I am well aware that not all of you are in my situation, particularly if you live in states that did not expand Medicaid or create their own exchanges. And matters will only get worse if the Supreme Court determines that subsidies under the Affordable Care Act do not apply to people in states that did not create their own exchanges. If that happens (and I’m not feeling particularly sanguine about the conservative majority doing the correct thing) all hell will break loose in those states who did not create their own exchanges. Millions of people will likely be unable to afford the insurance for which they signed up.
87 percent of the 5.4 million people enrolled in the federal marketplaces picked a plan using federal tax credits, lowering the amount of what they paid for their monthly premium from $346 to $82, on average. Without the tax credits, these families would be paying an average of $264 more per month, a 322 percent increase. Analysis from the Kaiser Family Foundation has also found that most of the individuals receiving subsidies are working families without access to employer-based coverage, earning between 200 and 300 percent of the federal poverty level. The subsidies paid for more than three-quarters of the cost of their premiums making it unlikely that they would be able to afford insurance otherwise.
Of course, that’s only the tip of the iceberg. As less people sign up for care, premiums for those who do have coverage are likely to rise significantly. In addition, insurance companies will lobby for the elimination of the prohibition against denying coverage to people with pre-existing conditions and other provisions in the ACA they do not like, such as the one that limits the amount they can spend on overhead expenses. Furthermore, any states will lose billions more in Federal dollars, especially in red states that opted out.
That means more sick people in states like Texas and Florida, and the return to the practice of people without insurance using the Emergency Department for primary care. Congressional Republicans have already indicated that they plan to either repeal the ACA, or “reform” it in ways that will disadvantage millions of people, many of them their own constituents.
Is the Affordable Care Act a perfect solution to our nation’s health care issues? Of course not, but it is already lowering costs, and if left unchanged by the Supreme Court, it is estimated to lower costs even more in future years.
Unfortunately, elections do matter. In the recent mid-term elections, many Democrats failed to stand behind the ACA (some even actively opposed it). In addition, the wave of outside money spent by conservative and corporately funded organizations spread the lie that the ACA was a socialist program destroying our health care system, rather than a program that creates real market competition among private health care insurers. What our health care system will look like in the future is now in the hands of five conservative justices in the Supreme Court. What they do may ultimately lead to the death of the ACA, and with it the return of millions of people to the ranks of the uninsured, along with more expensive and wasteful health care costs with the heaviest financial burden falling on those who can least afford it.
