This week, the Republican talking point is that Obamacare will collapse all on its own because it is not sustainable. Therefore it must be repealed. A second argument you are beginning to hear is that Obamacare is such a disaster that the aftershock of repealing it (market chaos, premium spikes for everyone) will be the fault of the law itself–and Democrats–not the fault of the repeal…. Hmm.
For now, let’s take them at their word that they actually want to replace the law so to mitigate the disruption of repealing it. If they really mean that, then we all need to be fully aware of the positive things the law actually accomplishes so we can measure whether GOP “repeal and replace” is worth the trouble. (The other option of simply fixing the current law appears to be off the table for now.)
Some facts to keep in mind during the debate:
- 10.2% of Americans have insurance through Obamacare–over 20 Million people
- Historic low number of uninsured: Only 10.9% of Americans are uninsured, down from 17.1% in 2013.
- Only 5% of children are now uninsured, and the percent of Poor/Near Poor and Hispanic uninsured have both been cut in half since Obamacare went into effect. (See the graphs on this CDC report.) If Republicans want to repeal Obamacare, are they willing to put a program in place that will cover this amount of people? Or will they say it is not worth the cost?
- Rate Increases: rate increases are coming for some people who get insurance through the Obamcare marketplace, but only 3% of Americans who receive unsubsidized insurance will be affected (see the chart further down in this link). If the main evidence of Obamacare’s imminent collapse is rate increases, how can hikes that only affect 3% of the country be considered a collapse?
- Maybe you’ve heard Republicans blame ALL recent employer-based insurence rate hikes on Obamacare–as if insurance rates never increased before the law went into effect. Yes, rates are expected to go up over 6% this year, which is high but not as high as it was in the 90s and 2000s with double-digit increases. According to one survey, post-Obamacare increases have been 3.1% compared to 5.6% in the 10 years before the law. Repealing Obamacare will not stop insurance rates from rising, and doing so may make rates rise faster and higher.
- 80% satisfaction rate of Obamacare recipients. Republicans seem to want to save people from a terrible service that users overwhelmingly approve of.
- There were 300,000 sign ups for Obamacare in the week after Trump’s election, which is tens of thousands more people than in the same period last year. The enrollment period will continue until 11 days after Trump’s Inauguration. Many people are flocking to a program that Republicans argue nobody wants.
- Bending the Cost Curve: Healthcare costs are rising much less steeply than they were before Obamacare:
- Phasing out Fee-for-Serivce Care: Other than providing near-universal coverage, the other main goal of Obamacare was to replace the fee-for-service economic model with value-based care that incentivizes medical decisions that produce greater health over greater cost. The idea is to heal people in a way that requires fewer hospital visits, fewer tests and treatments, by being proactive, intentional and coordinated. The law created a two bodies–the Center for Medicaid and Medicare Innovation, and the Accountable Care Organization–that empower hospitals and doctor’s networks to develop local solutions. Basically people in the health care industry propose a value-based care program, get it funded, and test the results. For example in Dayton, simply by setting up a phone bank panel of nurses to answer phones calls from certain types of patients who called the hospital they were able to prevent 500 ER visits in 2016. Another Obamacare-funded program that was able to avoid 3,000 ER visits and 1,800 hospital admissions per year. Read about these here. More than a third of Medicare payments to providers are now are for value instead of volume. The entire industry is in the middle of a transition to a cheaper and healthier business model. Any reform of Obamacare should keep this momentum going, not reverse it.