Should you measure Obamacare’s success by how many Americans have gotten health insurance, or by how good that coverage is?
It’s evident the health care law’s advocates and opponents hold vastly different views on that question as they mark its fifth birthday.
President Obama and Democrats spent this week touting how millions of previously uninsured Americans have gained coverage since the Affordable Care Act was passed half a decade ago — 16.4 million, by their count.
Some have become newly eligible for Medicaid while others have bought private health plans at online insurance marketplaces with the help of federal subsidies. Young people have been allowed to remain on their parents’ plans, and many with serious medical conditions have gained coverage, too.
“A lot of the attention has been rightly focused on people’s access to care, and that obviously was a huge motivator for us passing the Affordable Care Act — making sure that people who didn’t have health insurance have the security of health insurance,” Obama said Wednesday in a speech celebrating the law’s anniversary.
There’s no doubt the health care law means some Americans now have health insurance who didn’t have it before. But that’s not the whole story, say the law’s opponents, who point out that plans are tending to impose higher deductibles and narrower doctor networks in order to keep the monthly premium lower.
They argue that even though more Americans are uninsured, many are still grappling with big medical bills or experiencing difficulty in finding a doctor whose services are covered by their plan. Health insurance doesn’t guarantee health care access, they say.
“It’s easy to cover more people if you simply write checks with other people’s money,” said Doug Holtz-Eakin, president of the American Action Forum and former director of the Congressional Budget Office.
“The administration is very good at setting the goal posts where they want it,” he said. “They see the defined success of the Affordable Care Act by how many people sign up, and that should not be what the bar of success should be.”
Health insurance is complicated, and that’s allowed both sides to cherry pick data that proves their point. Besides the monthly premiums consumers pay, health plans also include a variety of other costs including deductibles, co-pays and annual limits. And plan offerings are different in every county.
The Kaiser Family Foundation has found that average premiums in the insurance exchanges grew only modestly this year, by 2 percent for mid-level silver plans and 4 percent for the lowest-cost bronze plans.
But research has also shown that many of the plans dramatically restrict which providers they’ll pay and set higher caps on how much consumers must pay out of pocket each year. About 70 percent of the bronze plans last year included narrow networks, according to the consulting firm McKinsey.
And Kaiser found that this year, the average deductible was $5,328 for a bronze plan and $2,556 for a silver plan, which is the most popular plan level among consumers.
“There are going to be lots of people that put off care because their policy is not that comprehensive,” said George Miller, a fellow with the Altarum Institute’s Center for Sustainable Health Spending.
But Miller also noted that insurers were already trending toward higher deductibles and restrictive networks even before the health care law was passed. And Republicans themselves have often emphasized the need for cheap, catastrophic coverage for healthy people who don’t need much care.
“Republicans tend to take the position that we want more market forces at play in this industry,” Miller said. “High-deductible plans do that.”
But on the highly politicized topic of Obamacare, nearly anything is fair game in Congress, and Republicans haven’t hesitated to sharply criticize the new insurance plans.
“It seems to me Obamacare plans often leave consumers with sticker shock and less access,” Sen. Tim Scott, R-S.C., said at a Senate Finance hearing last week themed on the law’s anniversary.
“The thing that gets lost in all this is, the deductibles are pretty staggering,” said Sen. John Thune, R-S.D. “Even if the argument is made that premiums have not gone up all that dramatically, would you define a health plan with these kinds of deductibles [as] ‘affordable’?”
