Originally posted in the Houston Chronicle on October 25, 2017
By Lisa Falkenberg
Yes, the Affordable Care Act has been beaten to a bloody pulp.
Yes, President Donald Trump further kneecapped the law last week by cutting off payments to insurers that help low-income people pay out-of-pocket medical costs.
Yes, the president tweeted gleefully Friday, with his trademark lack of punctuation: “The Democrats Obamacare is imploding.”
But here’s the truth that’s getting lost in the hype:
The ACA is not dead.
It is very much alive. It remains many Americans’ only access to affordable health care. It still contains subsidies, premium caps and other protections that Trump can’t touch.
And, although the current regime will take no great pains to tell you this in federally funded ad buys, open enrollment for a 2018 ACA health plan begins online at healthcare.gov and elsewhere on Nov. 1 and lasts until Dec. 15. An extension is planned for areas hard-hit by disasters, including Harvey, but that option may be available only by phone, not online.
It’s easy to be confused by the politics and drama, especially when much of the national media coverage has dwelled there.
There’s no doubt that Trump’s recent move contributes to market instability, as the Chronicle’s Jenny Deam has reported. Days before enrollment starts, we’re still not sure how much rates will jump. And it will have serious consequences for health consumers in the mid- to upper-income ranges. They’re the ones expected to bear the brunt of premium increases as insurers try to fill the void, predicted to be about $9 billion, left by Trump’s decision to yank the cost-sharing subsidy.
What many people don’t understand is that, even without that subsidy, insurers are still required by law to cover the lower cost of deductibles and co-payments for lower-income Americans. Their pocketbooks are largely shielded from the effects of Trump’s move. They generally include a family of four who makes between $24,600-$61,500 and qualifies for both cost-sharing subsidies and premium subsidies and also the next bracket: families who make up to $98,400 that receive only premium subsidies.
That leaves upper-middle class Americans on the hook for the shortfall. Those expected to be hardest hit are those who don’t qualify for any subsidy, generally a family of four with income of more than $98,400.
Not good for anyone
Trump’s high-stakes Jenga game with people’s health care isn’t good for anyone – a fact that Americans across the political spectrum, including those who don’t like the ACA, seem to understand. According to the October Kaiser Health Tracking Poll, about half of Americans view the ACA favorably but only 21 percent of those surveyed said Trump’s administration should try to make the law fail so they can replace it later. More than 70 percent said they should do what they can to make the ACA work.
Here in Texas, the uninsured capital of America, our elected statewide leaders remain hostile to “Obamacare” and refuse to encourage enrollment or even inform people about it. Despite that, it’s clear the ACA has helped reduce the uninsured population, which dropped from 22.1 percent in 2013 to 16.6 in 2016, according to U.S. Census data.
But now, health care advocates are concerned that modest progress will erode, and that even people untouched by Trump’s action will be scared off by the uncertainty, decide not to enroll, go uninsured, and then be stuck with the tax penalty and possibly far worse – thousands of dollars in medical bills in the case of an illness or other health emergency.
“There is a serious information gap going on,” says Kevin Nix with Legacy Community Health. Attacks on the ACA, he said, amount to “death by a thousand cuts. But we’re not to the death yet at all. This is still law, and it still helps people. That’s what we want to get across.”
Legacy and other nonprofits are helping to fill the information void.
“We’re tripling down this year in terms of money, time and people because the need is greater,” Nix said.
Legacy, a network of federally qualified health centers, this week is launching a public relations campaign to encourage Houstonians to enroll in the ACA and to provide free help in doing so.
The campaign, in English and Spanish, includes radio and social media ad buys in Houston and Beaumont, telethons, one-on-one patient consulting and on-the-ground information events at churches, festivals, universities and other locations, in coordination with Enroll Gulf Coast.
Getting help to navigate the federal health insurance marketplace has always been important, but this year, “shopping around and getting some help to shop around is more important than ever,” says Anne Dunkelberg, health policy expert and associate director of the Center for Public Policy Priorities in Austin.
She said consumers who are already insured through the ACA should never simply roll over last year’s plan, but this year, recent changes may skew plans and lead to some counterintuitive pricing. The best deal last year may not be the best now. And some people may be able to afford a better plan than they expected.
Just sign up
In a better world, you wouldn’t need to get this information from a newspaper column. In a better world, your president and your state leaders would be shouting it from the rooftops as they prioritize your health over their politics.
We don’t live in that world. But, thankfully, we don’t live in the warped realm of the president’s Twitter account, either. For the time being, we live in a nation that provides access to health insurance for people who wouldn’t otherwise have it. The law isn’t perfect, but it’s still standing. All you have to do is sign up.