Democracy is tricky for those convinced they know what’s best for everyone else. To lead they must often mislead because the people are unwilling to support their vision.
I think of this dynamic every time I read liberal writers declare that the Affordable Care Act is a smashing success or hear President Obama proclaim that the law has “worked out better than some of us anticipated.”
Just as President Clinton forced Americans to reconsider what the meaning of “is” is, Obama and his defenders are asking us to define success in new ways. If we take them at their word, what could Obama and his supporters possibly mean?
For starters, it is easier to determine what they cannot mean.
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They cannot mean that the ACA has delivered on the key claim used to ram the law through Congress: That Obamacare would be just another option in the health care landscape, a take-it-or-leave-it option that would allow Americans to keep their plans and their doctors. That was famously dubbed the lie of the year.
They cannot mean that the ACA has become popular. Five years after the law was passed and three years into its implementation, a majority of Americans have never approved of it.
And, as real world numbers keep pouring in, we now know they cannot mean that the ACA has delivered on Obama’s promise that it would be a boon to middle class families, sparking efficiencies and reforms that would save the average family $2,500 a year.
In fact, health care providers are seeking fat increases in premiums in 2016, when federal monies (especially risk corridors and “reinsurance” protections for especially expensive policyholders) expire. Blue Cross/Blue Shield of North Carolina is eligible for a $295 million federal payment this year.
For 2016, BSBCNC is requesting a rate increase of 25.7 percent, which is both whopping and consistent with national trends.
Unlike many people who trumpet the ACA, I actually use the program. I did not choose to join but was forced to as the law made insurance prohibitively expensive otherwise.
My experience reveals the program’s deep failure – and what supporters really mean by success.
Before Obamacare, my family had the type of insurance the president deemed “junk insurance.” We paid $440 per month for a plan with a $10,000 deductible.
In 2014, the first year of Obamacare, we acquired better insurance – $25 co-pays to see doctors, lower deductibles. With our $767 monthly subsidy, our premium was $525 per month.
In 2015, our premium on that policy skyrocketed to more than $800 per month.
So we opted for our old “junk insurance” policy, now with an $11,000 deductible. Our premium is now $568 per month, after a $690 subsidy.
Obamacare defenders will note that my premiums would have risen without the law. No doubt. But I’m not so sure that two-year increase would have been 30 percent.
But that is only part of the story because the actual premium, after adding in the subsidy, is $1,258 per month. That is what it would cost me to buy it outside the exchange.
$525 My monthly insurance premium in 2014
$800 The premium for the same insurance in 2015
The subsidy I depend on is based on my best estimate of my income. If I end up earning more, I will have to refund some – or all – of that subsidy.
Forget the 1 percent or even the 10 percent – this dynamic reveals how the ACA is punishingly expensive for the middle class.
The Wall Street Journal underscored this destructive dynamic: “The subsidies are most generous between 100 percent and 150 percent above the poverty line, where an Obamacare policy is essentially free. Some 76 percent of eligible individuals at that level are enrolled, report the consultants at Avalere Health. But enrollment drops to 41 percent between 151 percent and 200 percent of poverty, and then to 30 percent at 201-250. At 251-300, the share is 20 percent, and 16 percent for 301-400.”
Translation: Obamacare is a great deal for the poor and crushing for the middle class, many of whom are choosing to forsake insurance. In the individual market, it is moving us toward a two-tiered insurance market in which only the well-off and the poor can afford coverage. Let’s say I made too much to qualify for a subsidy. Would it be rational for me to spend $1,248 per month – or $14,976 per year – for a policy that provided few direct benefits until I spent another $11,000 to meet my deductible?
Claims that the ACA is succeeding can only mean that the law was never intended to help average families. It was always a way, along with Medicaid expansion, to cover the poor.
If it had been presented that way, it probably would not have passed. The middle class lie was essential to its “success.”
That is no way to run a democracy.
Contributing columnist J. Peder Zane can be reached at jpederzane@ jpederzane.com.