The Obamacare Exchanges Are a Mess and It’s Not Really Obama’s Fault

October 4, 2016, 3:05 PM UTC
Doctors Seek Higher Fees From Health Insurers
A doctor holds a stethoscope on September 5, 2012 in Berlin, Germany.
Adam Berry — Getty Images

Obamacare is hurting my family, and I blame…the Republicans.

Allow me to unpack that sentiment. The Schoolhouse Rock version of policy progress is: Congress passes law. Congress passes “technical fix” bill a year two later. Congress does more substantial changes a through a reauthorization a few years later. Ok maybe the “technical fix” part didn’t make the Schoolhouse Rock cartoon song but the point is that the normal, expected legislative process assumed constant refinement. That a law needed changes was not a sign of its failure; it was a sign of it being a law.

Today’s Republicans have taken the position that since the Affordable Care Act must be repealed, it must not be fixed. Why repair the car you’re about to send to the scrapyard? The problem of course is that six years have passed, and there has been no repeal nor major fixes.

Sadly, we’ve all gotten used to this. Ah these wacky partisan times! But it’s worth repeating: to try to damage Barack Obama, Republicans have intentionally made Americans suffer more. The target has always been the president; the victims turn out to be millions of families.

First, a small example from my own life. My business is too small to get good group insurance rates so last year I used the individual market. I live in New York City where no health insurance plans offer out of network coverage. No big deal, I thought. Those who want an alternative-medicine doctor who burns sage during the exam should have to pay for it anyway.

Then my son badly dislocated his shoulder and we discovered that the recommended surgeon for the $20,000 procedure was out of network. Gulp. I then started to notice that a lot of the complaints from friends about “f***ing Obamacare” related to this out-of-network provision, too.

Apparently this is a growing issue. In order to compete on price, many insurers narrow their roster of doctors. Addressing that would require regulatory solutions at the national or state level.

A related — and even more serious — problem is that one in four Americans has received huge surprise bills when a doctor who cared for them during a hospital visit was not in their network.

A few states are now trying to fix this problem, but a national solution would require congressional action.

There’s also a problem known as the “family glitch.” When an employer offers coverage to workers who are insured on the exchange, the employee gets the health care but the rest of her family can no longer get subsidies. As many as 4 million people have been hurt by this. Congress could easily solve this with a simple language change, but hasn’t.

Of course the mother of all self-inflicted wounds is the refusal of Republican lawmakers in 19 states to expand Medicaid despite the feds picking up almost the entire tab. About 19 million people – mostly the working poor, not the extreme poor – have been affected. Almost half live in Texas or Florida.

One study estimated that between 7,000 and 17,000 people will die as a result.

Let that sink in for a moment: thousands of people could die as a result of an intentional strategy of refusing to fix the fixable.

Related: Why I Don’t Feel Too Guilty About Outsourcing

It has become clear recently that some of the health care exchanges are seriously struggling because not enough healthy people have signed up. Some big insurers are threatening to leave as a result. In this case, the solutions are politically difficult. The Republican response (in theory, not in legislation) is to allow for no-frills policies. The progressive response is to allow for a public-option. If Congress refuses to make even easy improvements, it won’t surprise you to hear that GOP leaders have not allowed even consideration of either conservative or liberal improvements.

In the business world, it’s a truism that you put a product out and then continuously improve it. A complex law should be no different. “The Affordable Care Act needs to be implemented in a spirit of bipartisanship which of course is the opposite of what we’ve had,” says Harold Pollack, a leading health care policy scholar who has proposed a wide range of ACA improvements.

Notably, when George W. Bush’s Medicare Part D plan had a disastrous rollout, Democrats in DC and the states bailed it out.

Democrats have a small degree of blame on Obamacare. While they appropriately hail the program’s successes – the dramatic drop in the number of uninsured, for instance — they are often reluctant to talk about Obamacare’s problems lest they give ammunition to the foes. But in this case the main obstacle is Republicans.

Related: Dear Donald Trump: I’m a Small Business Owner, and I Want More Regulation

Some conservatives might say, Obamacare has created such a convoluted structure that it can only be replaced. Yet Congress has not even acted on the conservative proposals to replace Obamacare. The “replace” part of “repeal and replace” never materialized. Obvious fixes are viewed entirely through the lens of politics. The Weekly Standard, for instance, criticized one helpful legislative adjustment that did happen as “needlessly putting GOP fingerprints on” Obamacare.

For small businesses or individual families who rely on the individual health insurance market, that doesn’t do us much good. The Republican position at this point is that it’s better to let people suffer than muddy their political message. That’s not governing, that’s policy nihilism. And cruelty.