Higher prices and fewer choices are dogging the Affordable Care Act. Premiums are projected to rise 25 percent nationally next year, and fewer insurers will offer coverage in the marketplace exchanges. But the law, while still a work in progress, has already extended health coverage to millions of Americans and saved countless people from catastrophe by eliminating lifetime limits on coverage and banning exclusions for pre-existing conditions. It needs a president and a new Congress willing to fix its flaws and ensure that its notable progress is not reversed.
The Obama administration confirmed Monday that premiums in mid-level health plans will have large increases in most states next year, although the range varies wildly from a 116 percent increase in Arizona to a 3 percent decrease in Maine and Indiana. In Florida, a mid-level plan for a 27-year-old will go up 14 percent in 2017, according to federal data — from $238 a month to $270 a month. That’s less than $8 a week.
Even the increases come with caveats. Most people who buy insurance on the federal insurance marketplace qualify for tax subsidies and other cost reductions to keep their out-of-pocket expenses down. In Florida, 91 percent of enrollees get subsidies, which are also projected to rise.
But even President Barack Obama sees problems with his signature achievement. Speaking at Miami Dade College last week, he referred to the current state of the Affordable Care Act as a “starter home.” “The question we should be asking is,” he said, “what do we do about these growing pains?” He called for the federal government to provide a “public plan fallback” to create more competition and believes that additional tax credits would encourage more people to buy insurance. And he admonished states, including Florida, that have not expanded Medicaid.
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Still, the larger trends are disquieting. In August, insurance giant Aetna announced it was pulling out of the marketplace in Florida and 10 other states. That followed similar decisions by Humana and UnitedHealth Group to pull back, citing multi-million-dollar losses. Broadly speaking, not enough young, healthy people are signing up for health coverage through the marketplaces. Meanwhile, older, sicker people are enrolling and using more health care services, driving up costs. This is not an unexpected outcome, which is why the much-maligned individual mandate was included in the law.
It’s key to remember that the core functions of the law are working. More than 16 million Americans have gained health insurance. Children can stay on their parents’ plans longer. There are no more lifetime caps on care, and pre-existing conditions are covered. These successes should be unifying, but division has been the hallmark of the Affordable Care Act since its passage in 2010. Republicans in Congress have theatrically voted to repeal it dozens of times. They focus on news of price increases and other setbacks while failing to offer realistic alternatives. In Tallahassee, the Republican-led Legislature has steadfastly refused to expand Medicaid, which would cover 800,000 low-income Floridians.
The November election is a chance to elect new leaders who will build on the gains of the Affordable Care Act and craft solutions to control costs, to increase access and to insure more Americans. With premium hikes and fewer plan choices threatening the efficacy of the law, the stakes are high for millions who still lack affordable health care. The nonsensical cry of “repeal and replace” must give way to a sober bipartisan effort to keep the Affordable Care Act and to make it better.