The Problems with Obamacare and Finding a Better Way Forward.

There is a blinding glimpse of the obvious when looking at the Affordable Care Act (Obamacare) that was enacted back in 2010: It is a mind-numbing 2409 pages in length, and as a result it is just way too complex for most elected officials and the general public to understand, much less determine an intelligent and straightforward way to amend it.

It Starts with Name Confusion

A recent NY Times article reported that “A sizable minority of Americans don’t understand that Obamacare is just another name for the Affordable Care Act.” In the survey conducted by Morning Consult -  they reported that nearly one in three of the respondents said either they thought Obamacare and the ACA were different policies (17%) or didn’t know if they were the same or different (18%). 

NPR interviewed the Chief Research Officer Kyle Dropp of Morning Consult recently about the survey. He observed "Something like 35% of Americans did not realize they were the same policy. And that number spiked among Millennials and among adults with lower incomes. And these these are specific populations that might most be affected by some of the policy proposals."

It's really hard to debate an issue when some people are not even sure they are talking about the same thing. Establishing a baseline knowledge for a majority of Americans on the ACA might be a good place to start.

Attempts at Explaining ACA

We found several admirable attempts at explaining ACA - what it is and some the problems it is facing.

First the Obama White House You Tube channel offered up a white-board treatment of "What Obamacare Means for You." It does a decent job of identifying the major moving parts of the ACA in under three minutes.

The Kaiser Family Foundation "The You Tunes Get Ready for Obamacare" video is an entertaining way of explaining how most Americans get their health insurance under ACA, and how it works for various segments of the population. 

 Back to the Future

At this point it might make sense to take stock of where America is on the healthcare discussion, and what should be done with either revamping the ACA or simply starting over with a completely new legislative initiative on health care.

Looking back to the Federalist Papers (#62) written by James Madison we admire the passage that reads:

"It will be of little avail to the people, that the laws are made by men of their own choice, if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood..."

 This aptly describes the ACA at present.

More on The Affordable Care Act

Is it worth trying to salvage ACA or repeal it all together as Trump and many Congressional Republican have been advocating? Consider the following:

Back in 2013 the Washington DC based think tank Brookings Institute detailed why the implementation of the ACA has been so difficult, this also gives insights into why it may well be impossible to reform. Shortly after this report was released, The Week summarized key takeaways from the report:

1.     Government complexity comes with the territory.

2.     This “pro-market mindset” has also prevented the US from adopting a national system to provide or pay for universal healthcare (as many other countries did years ago)

3.     Instead of government-run healthcare, the U.S. has relied primarily on employers to purchase health coverage for their employees in the private market, with government policy filling in the gaps. The very fact the current system has so-called "gaps" makes it complex.

4.     Because the goal of ACA was to fill this last gap, which involved both expanding Medicaid and subsidizing purchases of private insurance, the legislation was inherently complex, noted Brookings: "There is no simple way to patch a patchwork."

5.     The law complicated things with the creation of the online insurance marketplaces. It would have been simpler to put the federal government in charge of creating exchanges, as the Brookings' analysis noted, and that was actually an early plan. But, because insurance is regulated at the state level and varies greatly across the country, the 50 states had to be involved.

A Better Way Forward?

The BBC published a great look at “Why is Obamacare so controversial?” late last year. It gives an overview of what the law does, some major data point highlights, and polling-based insights on consumer satisfaction with law. 

It also addresses why conservatives oppose the law, and lists some of the bigger problems.

The BBC identify the following ACA flaws that may be a good place to start fixing in the short term:

1.     Address the impact of the 2012 Supreme Court ruling that struck down the ACA provision saying states had to change how they administer Medicaid – which were supposed to be expanded to cover more poor people, while being funded by the Federal Government. Poor and working class families who don’t qualify for Medicare find themselves having to pay for private insurance or often-times going without coverage.

2.     Insurance companies are backing out of participating in Obamacare because fewer Americans than anticipated are signing up; that in turn raises insurances costs for everyone, which then further drives down participation. For some middle-income Americans, the subsidies available for buying Obamacare policies are not generous enough and the fines for not having coverage are too small to encourage them to enroll in plans.

3.     Premiums are to rise by an average of 25% in 2017. This increase was predicted at the start of the law, and the government subsides to help pay for insurance will also increase. But those who should be covered by the Medicaid expansion aren't eligible for those subsidies.

Instead of repealing ACA in its entirety, it might make sense to address some of the component part issues in the short-term, while stepping back and concurrently seeking a simpler and more holistic solution for the US healthcare quandary in the long-term, perhaps by 2020.