Oct 31, 2019 3:00 PM EST By Ricardo Alonso-Zaldivar, Associated Press
WASHINGTON (AP) — More Americans are going
without health insurance, and stable premiums plus greater choice next year
under the Obama health law aren’t likely to reverse that.
As sign-up season starts on Friday, the
Affordable Care Act has shown remarkable resiliency, but it has also fallen
short of expectations. Even many Democrats want to move on.
President Donald Trump doesn’t conceal his
disdain for “Obamacare” and keeps trying to dismantle the program.
Enrollment
has been slowly eroding since Trump took office, from 12.2 million in 2017 to
11.4 million this year.
During President Barack Obama’s tenure, open
enrollment involved a national campaign to get people signed up. The program’s
complexity was always a problem, and many lower-income people still don’t
understand they can get financial help with premiums.
That can translate to several million
uninsured people unaware they qualify for help. An analysis Thursday from the
consulting firm Avalere Health found that low-income residents in 96% of
counties served by HealthCare.gov can find a basic “bronze” plan at no cost to
them, factoring in subsidies. Bronze plans are skimpy, but experts say it beats
going uninsured.
Standard “silver” plans are available at no
additional cost in 25% of counties, and people eligible for generous subsidies
can find more robust “gold” plans for zero premium in 23% of counties, the
study found.
But the Trump administration says it’s not
specifically advertising that. Early on, it slashed the Obamacare ad budget.
Officials say they’re focused on providing a quality sign-up experience and
keeping the HealthCare.gov website running smoothly.
Democrats who once touted the health overhaul
as a generational achievement now see it as a stepping stone, not the final
word.
Presidential candidates Bernie Sanders and
Elizabeth Warren would bring the 20 million people covered under the law into a
new government-run system for all Americans. “It’s time for the next step,”
says Warren.
Former Vice President Joe Biden, who asserts
“Obamacare is working,” is proposing a major expansion of current ACA subsidies
and a whole new “public option” insurance program.
For John Gold, a self-employed graphic
designer from Maine, health care that’s stable, affordable and comprehensive
still feels more like a goal than a reality. He’s been covered by the ACA since
2014.
“It’s a great start, but it’s not the be-all
and end-all of health care,” he said.
Health care “takes up too much of my budget,
and it doesn’t need to,” explained Gold, who lives near Portland. “There are
appointments my doctor suggests, that I turn down because it’s going to cost me
$300.”
Gold’s income fluctuates, and when he makes
too much to qualify for subsidized premiums, he must pay full freight. He’s in
his 50s, so his monthly cost is higher, about $700. On top of that, the plan
comes with a $4,000 deductible and an $8,000 out-of-pocket limit, potentially
leaving him on the hook for a lot more.
Nonetheless, Gold said he hasn’t looked at the
cheaper alternative the Trump administration is touting, though it can cost up
to 60% less. One reason is “short-term plans” don’t have to cover pre-existing
medical conditions.
With the economy strong, it’s unusual for
progress to falter on America’s uninsured rate. Yet the Census Bureau reported
that 27.5 million people were uninsured in 2018, an increase of nearly 1.9
million from 2017, and the first time the rate went up in a decade.
Caroline Pearson, a health insurance expert
with NORC at the University of Chicago, a nonpartisan research organization,
said she doesn’t expect to see ACA coverage gains in 2020.
“Premiums are still expensive for people who
have other costs,” said Pearson. “It’s a challenging proposition unless you are
getting a big subsidy or really need insurance.”
Enrollment has been slowly eroding since Trump
took office, from 12.2 million in 2017 to 11.4 million this year. The drop has
come mainly in HealthCare.gov states, where the federal government runs sign-up
season. State-run insurance markets have held their own.
But Trump administration officials say they’re
doing just fine managing Obamacare. They recently announced that premiums for a
hypothetical 27-year-old choosing a standard plan will decline 4% on average in
2020 in HealthCare.gov states.
Despite relatively good news on premiums,
Trump’s actions still cast a shadow over the ACA’s future.
His administration is asking a federal appeals
court in New Orleans to strike down the entire law as unconstitutional. The
White House has released no plans to replace it.
Seema Verma, the top administration official
overseeing the health law, sounded confident in a recent appearance before a
House committee.
“The president has made clear that we will
have a plan of action to make sure Americans will have access to health care,”
Verma, head of the Centers for Medicare and Medicaid Services, said when asked about
the court case. But she added, “I’m not going to get into any specifics.”
A decision in the court case could come any
day. Whatever they decide, it’s likely to go to the Supreme Court.
Gold, the graphic designer from Maine, is
worried. “I do not trust them to replace it with something better,” he said.
Sign-up season ends Dec. 15 in most states.
Coverage starts Jan. 1.
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