Republicans in Congress and the Trump administration have done just about everything they can to it.
They’ve eliminated the requirement that people buy it. They’ve cut advertising for it. They’ve reduced the sign-up period by half and reduced funding for “navigators” who help people sign up for it.
But the Affordable Care Act lives.
And it’s not just surviving. It’s getting stronger. Blue Cross and Blue Shield of North Carolina announced this week that it has asked the state to approve lower rates for its subsidized ACA plans in 2019. On average, rates will be 4.1 percent lower. The request could have been at least 15 percent lower if the Trump administration and Congress had not undermined the health care plan, Blue Cross said.
“Rate decreases are fantastic news, because these decreases will make ACA plans more attractive and available to more consumers,” said Mark Van Arnam, who runs the N.C. Navigator Consortium in Raleigh. “This will likely lead to new shoppers entering the marketplace.”
Meanwhile, a poll released this week showed that 59 percent of adults surveyed support the ACA. Also notable is that 57 percent of those surveyed oppose President Trump’s health care policies, including the obstructing of the ACA, or, as the president prefers to call it, Obamacare.
By blunting the decrease in premium costs in North Carolina, the Republican sabotage is effectively imposing a tax that goes far beyond the 475,000 North Carolinians Blue Cross insures through the ACA. Many more taxpayers are being denied relief since the cost of most ACA policies is subsidized by federal dollars. Lower premiums would mean lower subsidies.
The good news on premiums has caveats. The drop comes after four years of Blue Cross rate increases as the company assessed the ACA market after the law took effect in 2014. And the reduction was achieved in part by removing Duke University Health System and WakeMed Health & Hospitals from the provider network for ACA customers. That change affected 12 counties in the Triangle region and could mean an estimated 50,000 Blue Cross customers will have to seek new doctors in the UNC Health alliance network.
Such shifts are inconvenient, but they are part of an important but often overlooked function of the ACA. While its opponents condemn its costs, the health care plan is designed to increase access and coverage to health care while pressuring providers to hold down costs. Both Duke and WakeMed said they would respond to being dropped by talking to other insurance companies that could offer plans that compete with Blue Cross’ ACA premiums.
ACA customers whose income is too high to qualify for subsidies complain that the new law sharply increased their health care premiums. It has also increased their coverage, accepted their preexisting conditions and protected them from medical bankruptcy in the event of major illness. Nonetheless, the unsubsidized rates are too high. Congress should focus on fixing that flaw rather than trying make the overall plan collapse.
Trump has granted those ACA customers facing high premiums a cheaper option by allowing the sale of plans that don’t comply with the ACA. Such plans don’t cover preexisting conditions and offer threadbare coverage with high deductibles. Healthy people who opt for such plans will weaken the ACA’s insurance pool and put themselves at risk.
Chris Hansen, the president of the American Cancer Society’s Cancer Action Network, told The New York Times that people with such policies who develop cancer could “face astronomical costs” and “may be forced to forgo treatment entirely because of costs.”
It’s time for the ACA’s opponents to concede that it works as a health care plan and there’s no political gain in attacking it without a plan to replace it. In North Carolina, where Republican resistance to the ACA has been especially strong, Republicans should see the value of embracing and improving it. Let the ACA be more broadly advertised, provide sign-up help and accept funding under the ACA to expand Medicaid to cover nearly a half-million North Carolinians.
The ACA has endured a partisan onslaught. Now let’s see what it can do with bipartisan support.