With the hourglass running out for his administration, President Barack Obama’s health care law is struggling in many parts of the country. Double-digit premium increases and exits by big-name insurers have caused some to wonder whether “Obamacare” will go down as a failed experiment.
If Democrat Hillary Clinton wins the White House, expect her to mount a rescue effort. But how much Clinton could do depends on finding willing partners in Congress and among Republican governors, a real political challenge.
“There are turbulent waters,” said Kathleen Sebelius, Obama’s first secretary of Health and Human Services. “But do I see this as a death knell? No.”
Next year’s health insurance sign-up season starts a week before the Nov. 8 election, and the previews have been brutal. Premiums are expected to go up sharply in many insurance marketplaces, which offer subsidized private coverage to people lacking access to job-based plans.
At the same time, retrenchment by insurers that have lost hundreds of millions of dollars means that more areas will become one-insurer markets, losing the benefits of competition. The consulting firm Avalere Health projects that seven states will have only a single insurer in each of their marketplace regions next year.
Administration officials say insurers set prices too low in a bid to gain market share, and the correction is leading to sticker shock. Insurers blame the problems on sicker-than-expected customers, disappointing enrollment and a premium stabilization system that failed to work as advertised. They also say some people are gaming the system, taking advantage of guaranteed coverage to get medical care only when they are sick.
Not all state markets are in trouble. What is more important, most of the 11 million people covered through HealthCare.gov and its state-run counterparts will be cushioned from premium increases by government subsidies that rise with the cost.
But many customers may have to switch to less comprehensive plans to keep their monthly premiums down. And millions of people who buy individual policies outside the government marketplaces get no financial help. They will have to pay the full increases or go without coverage and risk fines. (People with employer coverage and Medicare are largely unaffected.)
Tennessee’s insurance commissioner said recently that the individual health insurance market in her state is “very near collapse.” Premiums for the biggest insurer are expected to increase by an average of 62 percent. Two competitors will post average increases of 46 percent and 44 percent.
But because the spigot of federal subsidies remains wide open, an implosion of health insurance markets around the country seems unlikely. More than 8 out of 10 HealthCare.gov customers get subsidies covering about 70 percent of their total premiums. Instead, the damage is likely to be gradual. Rising premiums deter healthy people from signing up, leaving an insurance pool that’s more expensive to cover each succeeding year.
“My real concern is 2018,” said Caroline Pearson, a senior vice president with Avalere. “If there is no improvement in enrollment, we could see big sections of the country without any plans participating.”
If Republican Donald Trump wins the White House, he’d start dismantling the Affordable Care Act. But Clinton would come with a long list of proposed fixes, from rearranging benefits to introducing a government-sponsored “public option” as an alternative to private insurers. Not all her ideas would require congressional action.
“She is going to find it important to continue to expand health care,” said Joel Ario, a former Obama administration official who’s now with the consulting firm Mannatt Health.
People in the Clinton camp say she recognizes that as president she’d have to get Obama’s law working better, and is taking nothing off the table.
A look at some major ideas and their prospects:
PUBLIC OPTION
Clinton’s primary rival, Vermont Sen. Bernie Sanders, advocated “Medicare for all” and that pushed Clinton to a fuller embrace of government-run insurance. But Democrats could not get a public option through Congress even when they had undisputed control. Whichever party wins the Senate in November, the balance is expected to be close and Republicans are favored to retain control of the House.
While a new national insurance program seems a long shot, Obama’s law allows states to experiment. “I think the public option is more likely to be tested at a state level,” Sebelius said.
SWEETENING SUBSIDIES
Clinton has proposed more generous subsidies and tax credits for health care, which might also entice more people to sign up. But she’d have a tough time selling Republicans. It may be doable in the bargaining around budget and tax bills, but Democrats would be pressed to give up some of the health law’s requirements, including a premiums formula that tends to favor older people over young adults.
INCREMENTAL CHANGES
Whether it’s fixing a “family glitch” that can prevent dependents from getting subsidized coverage, requiring insurers to cover more routine services outside the annual deductible, or reworking the premium stabilization program for insurers, incremental changes seem to offer a president Clinton her easiest path.
MEDICAID EXPANSION
Expect a Clinton White House to tirelessly court the 19 states that have yet to expand Medicaid for low-income people. She’d ask Congress to provide the same three full years of federal financing that early-adopting states got under the health law. GOP governors would demand more flexibility with program rules.
“I’m just hoping that reality begins to sink in when she is inaugurated,” Sebelius said. “If the law is not going to go away, then let’s make it work.”
The Associated Press contributed to this article.
Everything is working and everybody is covered with affordable healthcare while seeing their chosen Doctor. The collapse was moved to after the Obama elections.
Another worthless law from the worthless obama!
Americans have the most expensive, yet mediocre healthcare in the world. I speak from experience. My wife is from the Philippines, and there is no national health care and few people have health insurance there. Payments are usually by cash directly to doctors and hospitals. In-patient stays that would cost $10,000 or more in the U.S. are usually about $500 or less there. It’s appalling what has happened in this country.
It doesn’t surprise me that an Obama administration official doesn’t see a problem with the system. Most brain active people do see problems. The greatest problem is the premise of Obamacare was flawed. Our nation’s medical problems are not caused by people not having health insurance. It is also foolish to believe that a government that is unable to control its own pocketbook would have the ability to manage the healthcare system. Medicare and Medicaid are both expensive programs where taxpayers get stuck footing a lot of the bill.
The solution is to go with a free market solution. Increased competition always seems to lower prices. Maybe the same would work in health care. Health care providers would look for ways to become price competitive. Currently many health care providers have found ways to game the system. With insurance companies picking up the tab, there isn’t much of an incentive for people to be good consumers when it comes to health care. The same people that spends time looking for a good deal on a toaster doesn’t waste any time looking for a health care provider, especially once they meet their annual deductible. If the person receiving the service has an incentive to hold a line on costs they may choose to skip tests and procedures that are expensive and provide little benefit.
Obamacare is a perfect example of what happens when government tries to manage things outside basic government.
if Donald Trump wins and then she is going to have to fix it.This article stinks you already have Hillary in the white house and the elections are not even over.
So true. All the media is reporting this way. I am counting on the silent majority. Trump will find ways to fix things, not alone, but he has the smarts to hire responsible people. Hillary could fix it too if she would pour all the money she collected in her foundation into Obamacare – then we all might benefit (half joking).
I lived and worked in Grand Forks, ND for a little while. And one day I had a conversation with a U of North Dakota Scandinavian languages professor at the University. He explained that the European Socialistic Health Care plans only cover so much, and every European who can afford it buys private insurance as a supplement. This is the direction we’re heading in America.
The same is true of the Canadian healthcare. I was in an 8 yr long drug study. There were several Canadians in the study. The Canadian healthcare insurance refused to pay for the medication (the only available medication to treat the disease and it will Never have a generic) because it cost too much.
Although I am not eligible for Odumo care. I have Medicare. The only medications I use are insulin (type 1 diabetic) each year I end up in the “donuthole”. You might as well call it the black hole. At the end of the year the cost of my insulin jumps to $650.00 for both. I am forced to choose 1 or the other. My only healthcare is Medicare. I am medically disabled with 3 chronic immune disorders. I worked until I was unemployable due to frequent illness.,The AWP cost of two of the medications I need but can not possibly afford are $50,000 and $40,000 minimum per year. I barely have enough money after rent to pay the cost of my insulin as is. To those of you that do not understand either type of diabetes. Neither type has anything to do with overconsumption of sugar or eating too much fat. It is the lack of or ineffectiveness of insulin use in the body. Even green leafy vegetables have carbohydrates (sugar) other color vegetables, such as carrots have even more. When I was diagnosed, I was slim,fit,active and had a lifetime of healthy eating habits.