The case for improving, not repealing the imperfect ACA

It is hard to make headlines with data when the sensational sells more easily. With the recent decision by the U.S. Supreme Court to permit the health care subsidies to continue in the 34 states where the federal exchange is used for the Affordable Care Act, the onus is now on the ACA to continue to work.

This imperfect and complex law is working pretty well, according to the Congressional Budget Office, Kaiser Family Foundation, the Commonwealth Fund, RAND Corporation and the Economic Policy Institute. Even Credit Suisse and Charles Schwab improved their outlook on U.S. Treasury Bonds last summer due in part to lower health care projections resulting from the ACA.

So, it should not be repealed, but it could use some improvements. One key improvement would be for the remaining 20-some states (like North Carolina and South Carolina) that have not expanded Medicaid to do so. In these states, the expansion would not only help those in need, per a George Washington University study, it also would help rural hospitals, the state’s economy and job creation.

Yet, what the ACA could use most is some honest discussion rather than political posturing. While working pretty well, the law needs some improvements such as increasing the hours worked threshold from 30 to 32 or more, making compliance easier for small employers and reconsidering the veracity of various fees charged employers. With the exception of the mandate to buy coverage, the law’s component parts are well-received. But when the nickname of Obamacare is used, the entire law is viewed less favorably. When ACA is used, the entire law favorability improves but is beneath 50 percent. Yet in Kentucky, when the ACA name of KyNect is used, it polls more favorably than either its national name or nickname.

Part of these survey findings relate to the overall complexity of health insurance in general and because of some real concerns over the law. Part of the negative findings relates to some who want National Health Care insurance, so the ACA did not go far enough in their eyes. Yet part of these findings relate to politicians using the name Obamacare as a weapon using labels meant to demonize the law. Some of these labels have even been used by presidential candidates. When strident, uninformed voters hear these labels, they tend to believe the labeler. Yet where I come from, when people use labels, it usually means their argument is less valid, so we should ask labelers more questions, not fewer.

While insurance cost increases have been dampened somewhat by the ACA per the CBO, with increased risk comes the potential for cost increases in areas where competition is small. The overall dampening effect will be more long term with more folks getting treatment before they become train wrecks. The short-term pressure on costs is evidenced by the headline-grabbing double-digit increases in some areas. But those are the headlines. I would look to organizations like the Kaiser Family Foundation, which notes that the average expected cost increases expected in 11 cities is 4.4 percent for 2016.

The ACA is here to stay. We need honest dialogue and not labels to discuss how to make it better. If you hear politicians using a demonic label, ask some questions about why they feel that way. You may find that they do not have any sound information to back up those claims.

This story was originally published August 3, 2015 at 4:58 PM with the headline "The case for improving, not repealing the imperfect ACA."